Date:____________

CREDIT APPLICATION
Company Name: ____________________________
Billing Address:
__________________________
__________________________
__________________________
Phone:__________________
Fax:____________________
E-Mail Address____________________

Shipping Address:
_____________________________
_____________________________
_____________________________
Phone: __________________
Fax:____________________

Company Web Address___________________________

Type of ownership:
Corporation

Partnership

Ltd. Partnership

LLC

Type of business_____________________

Sole proprietorship
Date Started:_______________
Tax Exempt:
Yes
No

Fed ID ____________________________
Resale number______________________
Are Purchase orders required? Yes
No
Type of account requesting
Net 30 Terms

COD

Credit Card

Owner and/or Officers:

Name: ____________________________________

Name: ______________________________

Title: _____________________________________

Title: _______________________________

Home Address: ______________________________

______________________________

Home Address: _______________________

_______________________

Home Phone: ________________________________

Home Phone: _________________________

Social Security Number:_______________________

Social SecurityNumber:_________________

Bank References:
Bank ___________________

Phone: ________________________

Address: ________________
________________

Account Number: _______________

Contact Name: ________________________

Please see next page

Trade references: (REQUIRED FOR NET 30 ACCOUNT) Please fill in all information
Company Name: ________________________________

Fax Number:_____________________

Address: ______________________________________

Phone Number: ____________________

______________________________________

Contact Person: ____________________

Company Name: ________________________________

Fax Number:_____________________

Address: ______________________________________

Phone Number: ____________________

______________________________________

Contact Person: ____________________

Company Name: ________________________________

Fax Number:_____________________

Address: ______________________________________

Phone Number: ____________________

______________________________________

Contact Person: ____________________

Terms and conditions of A-1 Distributing

In the event of default the undersigned agrees to pay all collection costs and/or attorney fees
together with costs of court. All payments are payable in Salt Lake County, Utah. No terms or conditions
hereof may be changed except by written consent of A-1 Distributing.
I/We understand that a credit report will be secured and that direct inquires may be made, and also
Agree to the release of information for the purpose of obtaining credit.
Company Name:_____________________________________
By: _______________________________________________

Title:_________________________

Signature:__________________________________________

Date:_________________________

Guarantee
In consideration of A-1 Distributing, extending credit hereunder, the undersigned, jointly and
Severally, and unconditionally guarantee and promise to pay A-1 Distributing, on demand, any and all
Indebtedness of the above named applicant to A-1 Distributing. This is a continuing guarantee, and the
obligations created hereby are unaffected by any change in the terms of the original indebtedness between A-1
Distributing and the above named applicant save that of payment.
I/We understand that a credit report will be secured and that direct inquiries may be made, and also
agree to the release of information for the purpose of obtaining credit.
Signature;____________________________________________
Date:________________________________________________

Application must be completed in full, whether applying for credit or COD