Credit Application - Gadgetronix IT

Name of business

Tax I.D Number

Address

City

Email

Phone Number

Business Type

In Business Since

Legal Form Under Which Business Operates

Corporation

Partnership

Proprietorship

If Division/Subsidiary, Name of Parent Company

In Business Since

Person Responsible for Business

Title

Address

City

Email

Country

Phone Number

Bank Reference #1

Bank Name

Address

Account No.

Phone Number

Bank Reference #2

Bank Name

Address

Account No.

Phone Number

Bank Reference #3

Bank Name

Address

Account No.

Phone Number

Trade Reference #1

Company Name

Contact Name

Phone Number

Address

Credit Limit

Account Opened Since

Credit Term / Period

Trade Reference #2

Company Name

Contact Name

Phone Number

Address

Credit Limit

Account Opened Since

Credit Term / Period

Trade Reference #3

Company Name

Contact Name

Phone Number

Address

Credit Limit

Account Opened Since

Credit Term / Period

Legal claim

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. Our credit limit will be:

Amount in Tshs

Within number of days

Date