Application For Credit Application For Credit Please enable JavaScript in your browser to complete this form.Date :Credit Limit Requested : Company Legal Name :Company Trade Name : Telephone # : Fax # : E-mail Address : *Years in Business :State of Incorporation :Purchase Order Required? ( ) Yes ( ) NoType of Business :Sales Rep : Business Operates as: Corporation Partnership Sole Proprietorship Federal ID # :Resale Certificate # :(Must supply copy of certificate with application)NAMES, TITLES, AND ADDRESSES OF OWNERS, PARTNERS AND/OR OFFICERS :Name Title Address Social Security #Name (copy)Title AddressSocial Security # Name Title (copy)AddressSocial Security # Name Title (copy) (copy)Address Social Security # TRADE REFERENCESCompany Name: AddressName:Address Name:AddressName: AddressContact PersonContact PersonContact PersonContact PersonContact PersonPhonePhoneFaxPhoneFaxPhoneFax PhoneFaxBANK REFERENCEBankNameAddressContact PhonePhone NumberPhoneFax Checking Acc Number A. CURRENT FINANCIAL STATEMENTS:Attached Will Mail Direct (On credit requests greater than $20,000) File Upload Click or drag a file to this area to upload. A. Person to Contact Regarding Accounts Payable:Unconditional And Irrevocable GuarantyThe undersigned for and in consideration of your extending credit at my/our request tohereinafter known as “Company” each personally guarantee to you payment at Surfaces by Pacific of any obligation of the Company and I/we hereby agree to bind myself/ourselves to pay you on demand any sum and all expenses of collection of the obligations and guaranty hereunder, including reasonable attorney’s fees, which may become due to you by the Company whenever the Company should fail to pay the same. I/we certify that all information provided is accurate and current. I/we agree to all terms and conditions of sale of Surfaces by Pacific. I/we also agree that all trade and bank references listed may release information to assist in the credit approval and collection process.BySignature without Title Individually and as an authorized agent of the CompanyDatePrint NameDate of BirthBy (copy)Signature without Title Individually and as an authorized agent of the CompanyDate (copy)Print Name Date of Birth This form must be filled out completely to avoid delays in processing.WebsiteSubmit