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Join Us
For Clients
Our Catalog
Application For Credit
Applicant
Business Information
Trade References
Bank References
Additional Notes
Confirmation
Business Name:
Parent Company Name:
Billing Address:
City:
State:
Zip:
Only fill out street address if billing address is different.
Street Address:
City:
State:
Zip:
Phone:
Fax:
HALO Sales Representative:
Credit Limit Requested:
Type of Organization:
Partnership
Corporation
Gov't
Non Profit
Proprietorship
Other
Name of Owner(s)
or Corporate Officers:
Month and Year Established:
/
D&B Number (if known):
State Sales Tax Status:
Number:
Exempt:
Taxable:
Accounts Payable Contact:
Contact Email Address:
Contact Phone:
If your company is tax exempt, please fax applicable tax exemption certificate
with your signed credit application.
* Please fill out all 3 trade references
Trade Reference
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 2
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 3
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 4
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 5
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 6
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 7
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 8
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 9
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Trade Reference 10
Company Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Bank Reference
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 2
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 3
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 4
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 5
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 6
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 7
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 8
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 9
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Account Number:
Line of Credit:
Secured:
Y
N
Bank Reference 10
Bank Name:
Phone:
Address:
Fax:
City, State Zip:
Contact Name:
Account Number:
Line of Credit:
Secured:
Y
N
Additional Notes:
I hereby certify that the information listed above and/or attached is warranted to be true. I authorize HALO Branded Solutions to investigate the above bank and trade references to obtain credit information. Should a credit availability be offered, applicant understands and agrees:
to pay all charges within payment terms as stated on each invoice;
that invoices not paid within HALO Branded Solutions payment terms as noted on the invoices are subject to late payment fees of 1.5% per month;
that all necessary collection and reasonable legal fees may be charged to applicant in the event of default or failure to pay for goods sold and delivered.
After you click "Submit", you will see a copy of your credit application. Please review this page for accuracy.
Name:
Title:
Signature:
__________________________________________________ Date:
NOTE: No Information will be saved until you click the "submit" button on the Confirmation tab.
The turn around time for processing this application is 2 to 5 business days, depending on the response time of your references.