Credit Application

Welcome

Please enter the name and email address of the person who will be completing and signing this application. This will be submitted to Docusign.

Name

Basic information

Full Legal Name or Individual Name

Mailing/Billing Address

Street

City

State

Zip Code

Phone

Fax

Federal Tax ID

Primary purchasing location (if known)

Salesman Name (if known)

Invoice Delivery Method (please check one)

Fax?

Email?

Statement Delivery Method (please check one)

Fax?

Email?

Purchase Orders Needed? (please check one)

Yes

Additional Information

Business Description

Business Type

Incorporation State

Incorporation Date

Years in Business

Gross Annual Sales

Credit Line Requested

Tax Resale Number

Delivery Address

Same as Mailing?

Street

City

State

Zip Code

If you have an accounts payable, please fill in the appropiate fields

AP Agent

AP Contact

If you have a Purchasing Contact, please fill in the appropiate fields

Purchasing Agent

Purchasing Contact

Owner \ Officers \ Principals

Please click Add at the bottom the page to add additional principals, up to a total of three. At least one principal is required.

Name

Title

Address

City

State

Zip

Phone

Name

Title

Address

City

State

Zip

Phone

Name

Title

Address

City

State

Zip

Phone

Trade References

All three references are required. If you intend to attach a list of references when you sign your application or are new in business with supporting documentation, check the box below to skip.

I will attach a list of trade references or further information on my new business: Yes

Reference #1

Company

Address

Best Contact Method

Phone, Email or Fax

Reference #2

Company

Address

Best Contact Method

Phone, Email or Fax

Reference #3

Company

Address

Best Contact Method

Phone, Email or Fax

Bank Reference

Bank

Address

Phone

Bank Officer

Account Number

Account Type

Account Number

Account Type

Submit

Thank you for completing Carroll’s credit application. Select submit to be redirected to Docusign for review and signing of your application for approval.