Reseller Support
Credit application
 Please fill in each of the following three forms. There are three total.
A link at the bottom of each form will take you to the next. 

Company Name:                   

Main Line of Business       

DBA:
If Subsidiary, Name of Parent Company

Address


City

State:

Zip Code

Tel:

Fax:

In Business Since:

Fed. Tax No.

DUNS No.

SIC No.

Reseller No.


Ever File Bankruptcy?
yes
no
Explain:


Have any pending Suites or Judgments?
yes
no
Date:

Explain:

Number of locations:

Type of business:
Corporation LLC Partnership Sole Proprietor

Business Operated From:
Home Commercial Building: Own Rent
Name of Landlord/Mortgage Holder:

Tel:

City:

State:

Number of years a current locations:

 Annual Sales Volume:
$101-$250K $251-$500K $501-$100K
$1M-$10M $10M-$20M $20M+
Number of employees:

Purchase Orders:
yes no
Average A/P Aging $:

Average AR Aging $:
Personal Information (fill out if Sole Proprietor, Partnership or Incorporated less than 1 year)
 Principal Name:

Title:

Social Security No:

Home Address:


City:

State:

Home Phone:

Have you ever filed Bankruptcy?
yes no
Date:

Explain:


Trade References

 Reference 1

 Company Name:

Contact Person:

Address:


City:

State:

Zip Code:

Phone Number:

Fax Number:

Account Number:

Reference 2

Company Name:

Contact Person:

Address:


City:

State:

Zip Code:

Phone Number:

Fax Number:

Account Number:

Reference 3

 Company Name:

Contact Person:

Address:


City:

State:

Zip Code:

Phone Number:

Fax Number:

Account Number:

The undersigned certifies that the above information, given for credit purposes, is true and correct and authorizes Kwong Quest Inc. and any credit bureau or other investigative agency to investigate references, statements or other data listed or accompanying this application, including banking records as a part of said investigation.


Authorized Signature

 Date:

Name (print)

Title:

Print this form now, sign it, then: complete the credit application guarantee form by clicking here.