Patriot Credit Application
Thank you for taking an interest in Patriot Strapping. We look forward to working with you in the future. We will review your application and contact you shortly.
Company Name: *
Your answer
DBA: (If different)
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Contact Person: *
Your answer
Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip code: *
Your answer
Phone number: *
Your answer
Fax Number: *
Your answer
Federal Tax ID or Social Security Number:
Your answer
Type of Business:
Your answer
Number of Employees:
Your answer
Date Business was Established?
Your answer
Types of Products you will Purchase?
Your answer
Amount of Credit Requested:
Your answer
Are you a Corporation?
If you are a Corporation, please enter the following information for your three Chief Corporate officers:
Name, Title, and address.
Your answer
If you are a Corporation, please enter the following information for your Resident Agent:
Name and Address.
Your answer
Are you a Partnership?
If you are a Partnership, please list the following information for each of your partners:
Name and Address.
Your answer
Are you a Sole Proprietorship?
Are you sales tax exempt?
Have you ever had credit with us before?
If yes, under what name?
Your answer
Please List Authorized purchasers:
Your answer
Purchase order required?
Trade References:
Please List three References: Name, Address and Phone Number.
Your answer
Bank References:
Please list two Bank References: Bank Name, Phone, Contact Person, Account Number and Address.
Your answer
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