Finance Request Form

Sales Person

Amount of Credit Needed

Amount of Credit Approved

Company Name

Company Address

City

State/Province

Zip/Postal

Phone Number

Fax Number

Type of Business Corporation Partnership Individual

Annual Sales Volume

Number of Employees

Number of Years in Business

Dunn & Bradstreet #

Federal Tax ID #

NAME & TITLE OF PRINCIPLE OWNERS

Name

Title

Name

Title

CREDIT_INFORMATION

Bank Name

Contact Person

Address

City

State/Province

Zip Postal

Phone Number

Fax Number

TRADE &/OR SUPPLIER REFRENCES

Name # 1

Address

Phone

Name # 2

Address

Phone #2

Please feel free to leave any questions or comments here.