Impressions Inc. : Customer Service Center : Credit App




				Credit Application Date Credit Limit Requested $ Company Information Name Phone DBA (if different) Fax Address City, State, Zip Email Type of company Corporation Partnership Limited Liability Company Sole Proprietor Other If other, please specify Federal Tax ID# or Social Security Number Resale # Tax Exempt # State where incorporated How long in business? Number of employees Ownership Information Please complete the below information for all officers, partners, members, and owners. Name Title Ownership % Home Address Home Phone Name Title Ownership % Home Address Home Phone Name Title Ownership % Home Address Home Phone Bank Reference Name of Bank Bank Address Phone Contact Name Account # Type of Account Trade References Please list three significant business relationshps. Name Address Phone Contact Name Name Address Phone Contact Name Name Address Phone Contact Name Mortgage Holder/Landlord Information Do you rent or own premises that the business occupies? Rent Own Years at location Mortgage Holder/Landlord Name Contact Person Address Phone Has the company or any officer, partner, member, or owner ever filed bankruptcy? Yes No If Yes, please describe Has your compnay or any company officer, partner, member, or owner been associated with as an officer, partner, member, or owner ever had credit with us before? Yes No If Yes, under what name I authorize Impressions to perform a credit check Yes No