Business Credit Reports

Company Information

Company Name

DBA

Address

City

State/Province

Zip/Postal Code

Country

Phone

Billing Address

Billing City

Billing State/Province

Billing Zip/Postal Code

Billing Country

Tax Identification #

Type of Business

# of Years in Business

# of Employees

Previous Address

Website

Contact Information

First Name

Last Name

Title

Phone

Fax

Accounts Payable Contact Information

First Name

Last Name

Title

Phone

Fax

Bank References

Bank

Account #

Phone

Contact

Address

City

State

Zip

Parent Company Information

Company

Address

City

State

Zip

Country

Owner/Partner Information (only needed if partnership or sole proprietorship)

Name

Address

City

State

Zip

Country

Phone

SSN

Previous Company Information (only needed if in business for less than a year)

Previous Company

Address

City

State

Zip

Country

Credit Reference #1

Company

Contact

Phone

Fax

Credit Reference #2

Company

Contact

Phone

Fax

Credit Reference #3

Company

Contact

Phone

Fax

Request

Requested Amount

Comments (400 characters max)

Supporting Documentation

Are you Tax Exempt? If yes, please upload your Tax Exemption form.

Click the Browse / Choose Files button above to select the files you want to send. Then click the Upload button.
Please keep individual file sizes to 4MB or less.

Uploaded Documents

Terms

I understand the following and will abide by your company regulations if credit is granted:
If credit is granted, we will notify Wauseon Machine of any changes in ownership. We agree to pay all invoices within 30 days of invoice date or per contract. If payment is over 30 days, we may be charged a 1.5% or 18% annual finance charge. If payment remains over 30 days, Wauseon Machine may cancel credit and place our account on COD. If our company defaults on payment, we agree to pay all attorney and/or collection related expenses.

I accept the above terms.

Submit the Request

By clicking 'Submit', I/We authorize Wauseon Machine & Mfg or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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