Credit Application - Baron Hardware

Baron Manufacturing, LLC

703 Baker Street, Itasca, IL 60143

If you already have a credit application filled out, please attach at the end of this form

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Step 1

Business Name

Individual

S.S. #

Addresss

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Phone Number

Area Code

Phone Number

Name of Principal/Officer

How long in operation?

Corporation

Proprieter

Partnership

Address of the Current Bank

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Checking account #

Savings account #

Phone Number

Area Code

Phone Number

Bank contact

First Name

Last Name

If at the above bank for less than six (6) months, provide bank name, phone number, and account number below.

Bank name

Bank account #

Area Code

Phone

List name and address(es) of current supplier(s)

What do you expect to purchase in the next twelve (12) months?

How much are you requesting for a credit line?

Terms of sale have been fully explained and I understand that if an account is established, my credit line is subject to periodic review. Also, shipments may be held if my account is delinquent or exceeds the established line of credit.

In order to expedite the opening of your new account, please provide as much information as possible.

I understand the above information is given in confidence for the sole purpose of establishing an open account. I further certify that the facts provided by me for this purpose are true and exact

Customer e-signature

By signing, you are personally guaranteeing payment of a balance due on your account

Date

Due to the frequency of banks refusing to provide data without written authorization from their client, we request that you complete the following. Your cooperation will expedite processing your account.

I authorize

to provide information to

On my account(s)

Customer e-signature

Date

Credit application and/or credit references