Credit Application

Please fill out all of the fields as completely as possible.

Legal Name of Company(Required)

Date(Required)

Trade Name (DBA)(Required)

Phone Number(Required)

Business Type(Required)

Incorporated

Proprietorship

Partnership

Federal (Tax ID#)(Required)

Duns Number(Required)

Years in Business(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province ZIP / Postal Code

Accounts Payable Contact

Name(Required)

Phone(Required)

Email(Required)

Major Trade References

At least 3 references are required.

Name of Company(Required)

Address(Required)

City State / Province ZIP / Postal Code

Phone(Required)

Email(Required)

Name of Company(Required)

Address(Required)

City State / Province ZIP / Postal Code

Phone(Required)

Email(Required)

Name of Company(Required)

Address(Required)

City State / Province ZIP / Postal Code

Phone(Required)

Email(Required)

Name of Company

Address

City State / Province ZIP / Postal Code

Phone

Email

Name of Company

Address

City State / Province ZIP / Postal Code

Phone

Email

Requested Credit Limit(Required)

Are you tax exempt(Required)

Yes

No

Please upload your tax exemption certificate

Accepted file types: pdf, jpg, png, Max. file size: 128 MB.

Financial Institution Information

Name of institution(Required)

Type of Account(Required)

Checking

Savings

How many years have you been with this institution?(Required)

Please upload a copy of your W9(Required)

Max. file size: 128 MB.

To induce Nash Distribution to extend a line of credit for purchase under credit sales terms as stated on invoices, we authorize Nash Distribution to contact these references and banks listed above. We also understand that this information will be held in strict confidence and be used solely for the consideration of extension of credit to us. It is understood that a service charge of 1 1/2% of the balance per month will be added to an account past due. Customer is subject to collection and or legal action and to pay reasonable collection/attorney’s fees resulting from such action.

Name(Required)

First Last

Title(Required)

Signature(Required)

Check this box if an additional person needs to sign

Check this box if an additional person needs to sign

Name

First Last

Title

Signature