CREDIT APPLICATION
Office Location Requested Credit Limit
$
CLIENT INFORMATION
Corporate Name d.b.a Telephone Fax
Street Address City State Zip
Billing Address City State Zip
Federal Tax Identification No. DUNS No.
 
BUSINESS CREDIT INFORMATION
Principal(s) Authorized Officer(s) Title SS#
Home Mailing Address City State Zip
Principal(s) Authorized Officer(s) Title SS#
Home Mailing Address City State Zip
Person to Contact Regarding the Account Accounts Payable Contact
Business Type Business Sector Financials Available?
Sole Owner Partnership Corporation Public Private Non-Profit Government Yes No
Number of Years in Business What Does Business Do? SIC Code
 
BANK REFERENCES
Bank Name Account # Contact Name
Bank Address City State Zip
Branch Telephone
 
TRADE REFERENCES
Trade Reference Name Address City State Zip Phone
Trade Reference Name Address City State Zip Phone
Trade Reference Name Address City State Zip Phone
Trade Reference Name Address City State Zip Phone
 
AUTHORIZATION AND DIGITAL SIGNATURE
As a prospective client of WillStaff Worldwide, I authorize the staff of WillStaff Worldwide to conduct an investigation into the credit history of the company herein applying for credit privileges. As a principal of the above named firm, I also grant permission to investigate my personal credit history as a possible means of issuing credit to the firm where I hold a significant interest. As permission to conduct this investigation, I offer my digital signature below:
Name: Title: Date: