Credit Application

Corporate Info

Legal Business Name

Date Established

Phone Number

Trade Name (if different from Legal Business Name / dba)

Fax Number

Address

City

State

ZipCode

Silicon Mechanics Salesrep

Accounts Payable Contact

Contact Name

Contact Phone

Contact Email

Digital Invoice Delivery Email (Required)

Corporate Profile

Tax ID / Fed ID

D&B Number

Stock Symbol

Annual Sales Volume

Bank / Trade Reference Data Must have account number under same dba and/or legal name

Bank Name

Checking Account #

Savings Account #

Loan Account #

Contact Name

Contact Phone

Contact Email

Trade References Please provide at least 3 trade references

Name

Terms

Address

Phone

Credit Request

Account Terms Requested

Requested Credit Limit

Tax-Exempt Organizations Optional

Certify Information / Financial Release

I certify that the above information is true and correct. Furthermore, I authorize financial institutions to release necessary information to Silicon Mechanics in order to verify the information contained herein.