BA_Logo.bmp (327238 bytes) Credit Application
P.O. Box 1240 Mukilteo, WA 98275
(800)426-8313 Fax(425)710-0667		 Print Application
DATE
Firm Name:
Contact Person:
Address:
City:
 State:
 Zip:
Type of Business:
 Year Business Opened
Phone:
 Fax:
Email:
Federal ID or SS#:
 Principals name:

Bank Reference
Firm Name:
Contact Person:
Address:
City:
 State:
 Zip:

Trade Reference
Firm Name:
Phone:
Firm Name:
Phone:
Firm Name:
Phone:

The undersigned herby agrees that should a credit account be opened in the event of default in the payment of any amount due, and if such account is submitted to a collection authority, to pay an additional charge equal to the cost of collection including court costs.

The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report of the undersigned by the above named business credit grantor, from time to time as may be needed in the credit evaluation process.

Company:
Date:
Signature:
_____________________________________________________ 		Title:
Please Print your name: