Credit Application

  • Business Structure

  • Company Principals in Charge of Business Activity

  • First Name Last Name Position Home Address Phone Number City State Zip Code Drivers License Number Social Security Number % Of Ownership  
    There are no Principals.
  • Bank Reference

  • Trade References

  • Company Name Account Number Address Phone Number City State Zip Code  
    There are no Trade References.
  • Statement of Data Accuracy and Release of Authority to Verify

  • The undersigned, for the purpose of procuring and establishing credit from time to time with Interior Supply, Inc. hereafter referred to as Supplier and to induce Supplier to permit the undersigned Customer to become indebted to Supplier for the purchase of goods, materials, and/or services, furnishes the above business and personal credit information. The undersigned, (jointly and individually, if applicable) certify that all information in this Credit Application is complete, factual and correct, and understands that Supplier will rely on the accuracy of this information for any credit that may be extended. If any statement is not true in any material respect or if the Customer should file for bankruptcy or if any other creditor tries to seize the Customer’s property or if any adverse change occurs in the Customer’s financial condition, at the Supplier’s election, you may declare all of my indebtedness and obligations to you immediately due and payable without demand or notice. The undersigned hereby expressly authorizes Supplier to contact any parties listed by Customer herein for the purpose of verifying any information contained in this Credit Application. The undersigned hereby waives any right of privacy which it may have in any such information, and waives the effect and benefit of any statutes or regulations which give it the right to control or bar the releases of such credit information. Further, the undersigned hereby authorizes such parties to disclose to Supplier whatever information they may have with respect to the undersigned’s credit or financial status and hereby agree to hold such parties harmless for any such disclosure. If any representations made in this Credit Application are untrue, the undersigned agrees that all obligations of the Customer to, or held by, Supplier shall immediately become due and payable without demand or notice. The undersigned hereby acknowledges receipt of a copy of this Credit Application.
  • Signature

  • This field is for validation purposes and should be left unchanged.