Retailer Credit Application Template

Template Series · 10

Retailer Credit Application

Credit Application

Financial Document

From

________________

To

________________

Date

________________

Version

1.0

01Business Information

1.1. Legal EntityBusiness Name: ________________

Legal Structure: ________________ (LLC / Corp / Sole Proprietor / Other)

Federal Tax ID / EIN: ________________

Years in Business: ________________

1.2. Principal ContactOwner / Buyer Name: ________________

Title: ________________

Email: ________________ Phone: ________________

1.3. Billing AddressAddress: ________________

City / State / ZIP: ________________

02Store & Channel Information

2.1. Store Type☐ Brick & Mortar ☐ Online Only ☐ Both

Number of Physical Locations: ______

Website / Online Store URL: ________________

2.2. Annual Purchase VolumeEstimated annual wholesale purchasing (all vendors): $______

Average order size (per vendor): $______

Primary product categories: ________________

03Trade References

3.1. Trade ReferencesPlease provide three current wholesale vendors as trade references.

Reference 1:
Company: ________________ Contact: ________________ Phone: ________________

Reference 2:
Company: ________________ Contact: ________________ Phone: ________________

Reference 3:
Company: ________________ Contact: ________________ Phone: ________________

04Credit Terms Requested & Authorization

4.1. Terms Requested☐ Net 30 ☐ Net 60 ☐ Net 90 ☐ Other: ______

Requested credit limit: $______

4.2. AuthorizationBy signing below, the applicant authorizes ________________ to contact the trade references listed above and to verify business information. The applicant certifies that the information provided is accurate and agrees to the Wholesale Terms & Conditions of ________________.