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DDB Unlimited Credit Application

CONFIDENTIAL

Credit Application

PLEASE FILL THIS SHEET OUT COMPLETELY.

Credit application can not be processed without the amount of credit being requested and a signature. Terms are net 30 days.

Credit Requested

Amount of Credit Being Requested:

Requested By:

User Email:

Type of Business:

Corp Sole-Proprietor Partnership LLC Other

(If other please specify)

Company Information

Company Name:
Billing Address:
City, St, Zip:
D-N-B #:
Contact Name:
A/P Contact Name:
Tax Status: Tax Exempt Taxable

# Years in Business:
Phone # and Ext:
Reseller ID #:
Tax ID #:
Email Address:
Email Address:

*You'll be taken to our Exemption Portal upon completion of this form.

Bank Reference

Bank/Branch:
Billing Address:
City, St, Zip:
Contact Name:

Account #:
Phone # and Ext:
Fax #:
Email Address :

Trade Reference - At Least 3 are required

Type of Business:
Billing Address:
City, St, Zip:
Contact Name:

Account #:
Phone # and Ext:
Fax #:
Email Address:

Type of Business:
Billing Address:
City, St, Zip:
Contact Name:

Account #:
Phone # and Ext:
Fax #:
Email Address:

Type of Business:
Billing Address:
City, St, Zip:
Contact Name:

Account #:
Phone # and Ext:
Fax #:
Email Address:

CONFIDENTIAL

This application represents that the information set forth in this application is true, complete and accurate. Applicant hereby authorizes DDB Unlimited Inc. to verify such information.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

April 8, 2015 1:18 am EDT

DDB Unlimited Credit Application Uploaded by Sales Representative - noreply@ddbunlimited.com IP 75.111.34.48

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