Credit Application

Company Name

Owner/President's Name

Company Address

City

State

Zip

Phone Number

Fax Number

Email Address

Company Website

Accounting Contact

Email for sending Invoices

If incorporated, what State

Federal ID # or Social Security #

Sales Tax Exemption #

Upload copy of exemption certificate here (or fax to 952-920-8246)

Years in business

Annual sales volume

Number of employees

Estimated credit line requested

Credit Reference #1 - Company Name, Phone, Fax, Contact Name

Credit Reference #2 - Company Name, Phone, Fax, Contact Name

Credit Reference #3 - Company Name, Phone, Fax, Contact Name

Bank Reference - Bank Name, Phone, Fax, Contact Name

By signing this application, we authorize Storlie Company to check our credit history. We authorize our banks, and any other references listed to release and/or verify information to Storlie Company, Inc. If Storlie Company accepts this application, we agree to be bound by Storlie Company, Inc. credit terms. Storlie Company reserves the right to change any balance owing past 60 days to the above referenced Credit Card. We further agree to pay all reasonable finance charges, penalties, collection fees, and legal fees in the event it is necessary to turn this account over for collection. Officers, stockholders, partners, owners and person signing this form, is/are personally responsible for payment. Typing your name and dating the application constitutes your signature.

Your Title

Today's Date