Credit Application Primary Contact Information Name * First Name Last Name TItle Email * Phone * Country (###) ### #### Company Information Legal Business Name * DBA Address Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Identification Number (EIN) * Business Owner's Name(s) * Business Type * Corporation (S or C) Limited Liability Company (LLC) Sole Proprietorship Partnership Cooperative Other Business References Reference #1 Company Name * Contact Name * Phone * Country (###) ### #### Reference #2 Company Name * Contact Name * Phone * Country (###) ### #### Reference #3 Company Name * Contact Name * Phone * Country (###) ### #### Bank Reference Bank Name * Bank Contact * Bank Phone Number * Country (###) ### #### Payment Preferences Send Invoices via: * Email Mail Purchase Order Required? * Yes No Are your purchases Tax Exempt? * Yes No If you answered "Yes" to Tax Exempt: please send Tax Exempt documentation to csi@csi2.com for verification. How does your company usually pay invoices? * Check Credit Card EFT//ACH Other If Accounts Payable differs from Primary Contact, complete below: Accounts Payable Contact Name First Name Last Name Accounts Payable Email or Mailing Address * Credit Application Authorization * I am an authorized representative of my company that has the authority to make credit\purchasing decisions and hereby authorize the release of any information necessary to assist in establishing a line of credit with CSI. Authorized Representative Electronic Signature * Today's Date * MM DD YYYY Thank you for your credit application! We will process it as soon as possible.If you answered "Yes" to Tax Exempt: please send Tax Exempt documentation to csi@csi2.com for verification.
