Net-30 credit application form — for new B2B customers asking for terms

Variables to fill in

{{provider_name}}

Your business name as it appears on the account.

{{credit_threshold}}

Your standard trade-credit threshold above which an application is required.

{{governing_state}}

Your state — governs the application's contractual elements.

The template

Select all and copy. Replace the {{double-brace}} placeholders with your details.

{{provider_name}} — APPLICATION FOR TRADE CREDIT

Date submitted: ___________________________________________

SECTION 1 — APPLICANT INFORMATION

Legal entity name: __________________________________________
Trade name (DBA), if different: _____________________________
Entity type: ☐ Sole proprietorship  ☐ Partnership  ☐ LLC  ☐ Corporation  ☐ Other: ___________________________________________
State of formation: __________________________________________
Year founded: __________________________________________
Federal EIN (or SSN for sole proprietor): _____________________________________________________________________________

Business address: __________________________________________
                  __________________________________________
                  __________________________________________

Billing contact name: ___________________________________________________________________
Billing email: ___________________________________________________________________
Billing phone: ___________________________________________________________________

SECTION 2 — REQUESTED TERMS

Requested credit limit: $______________
Requested payment terms: ☐ Net 15  ☐ Net 30  ☐ Net 45  ☐ Other: ____________

SECTION 3 — TRADE REFERENCES

Please list three current vendors who extend you credit and can verify your payment history. We may contact them.

Reference 1
Vendor: __________________________________________
Contact: __________________________________________
Phone: ___________________________________________
Email: ___________________________________________
Approximate monthly purchase volume: __________________________________________

Reference 2
Vendor: __________________________________________
Contact: __________________________________________
Phone: ___________________________________________
Email: ___________________________________________
Approximate monthly purchase volume: __________________________________________

Reference 3
Vendor: __________________________________________
Contact: __________________________________________
Phone: ___________________________________________
Email: ___________________________________________
Approximate monthly purchase volume: __________________________________________

SECTION 4 — BANK REFERENCE

Bank name: __________________________________________
Branch: __________________________________________
Account officer: __________________________________________
Phone: __________________________________________

SECTION 5 — BUSINESS CREDIT REPORT CONSENT

By signing below, the undersigned authorizes {{provider_name}} to obtain a business credit report on the legal entity named in Section 1 from one or more commercial credit reporting agencies, including but not limited to Dun & Bradstreet, Experian Business, and Equifax Business. The undersigned acknowledges that business credit reports are not consumer reports and are not subject to the Fair Credit Reporting Act.

Signed by an authorized representative of the entity:

Name: __________________________________________
Title: __________________________________________
Signature: ____________________________________  Date: __________

SECTION 6 — PERSONAL GUARANTEE AND PERSONAL CREDIT CONSENT (REQUIRED FOR SOLE PROPRIETORS, AND FOR OTHER ENTITIES WHERE THE OWNER WILL PERSONALLY GUARANTEE)

The undersigned, in their individual capacity, personally guarantees the prompt and full payment of all amounts owed to {{provider_name}} by the entity named in Section 1, up to the credit limit approved by {{provider_name}}. This personal guarantee is a continuing guarantee and remains in effect until revoked in writing.

The undersigned further authorizes {{provider_name}} to obtain a consumer credit report on the undersigned in the undersigned's individual capacity, in connection with the credit transaction contemplated by this application. The undersigned acknowledges that this authorization satisfies the permissible-purpose requirement of the Fair Credit Reporting Act, 15 U.S.C. § 1681b(a)(3)(A).

Personal guarantor:

Name: __________________________________________
Home address: __________________________________________
                __________________________________________
SSN (last 4 only required for credit pull): ____________________________________________________________________
Date of birth: __________________________________________

Signature: ____________________________________  Date: __________

SECTION 7 — TERMS OF EXTENSION

If approved, credit will be extended subject to {{provider_name}}'s standard terms and conditions, the law of {{governing_state}}, and the following:

(a) Invoices are due in full by the date stated. Past-due invoices accrue interest at the rate stated in the underlying agreement.
(b) {{provider_name}} may modify or revoke the credit limit at any time on written notice.
(c) If any invoice remains unpaid more than thirty (30) days past due, the personal guarantor (if any) becomes immediately liable for the unpaid amount.
(d) {{provider_name}} reserves the right to require deposit, COD, or other security in lieu of open terms at any time.

SECTION 8 — ACKNOWLEDGMENT

The undersigned certifies that the information above is true and accurate to the best of the undersigned's knowledge.

Acknowledged by an authorized representative:

Name: __________________________________________
Title: __________________________________________
Signature: ____________________________________  Date: __________

---

This template is general-purpose educational content, not legal advice. State law varies and attorney review is recommended before use. Syntharra is not your attorney.

Credit-screen new B2B customers, then let Syntharra handle the day-3 call when invoices age past due.

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