Business Credit Card Application

Business name *

DBA (if applicable)

Address

Business Address *

City *

State *

Zip Code *

Business Number *

Business email *

Company website

Business Type *

Cooperative
Corporation
LLC
Non-profit
Partnership
Sole Proprietor
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Business Industry *

EIN *

State of Incorporation *

Date Business Was Established: *

Numbers of Employees *

Annual Gross Revenue: *

Estimated Monthly Credit Card Spend:

Authorized Officer / Business Owner Information (Personal Guarantor)

First Name *

Last Name *

Title / Role: *

Date of Birth *

Social Security Number *

Home Address *

Street, City, State and Zip Code

Phone *

Email *

% Ownership in Business: *

Trade & Banking References

Primary Bank Name: *

Bank Account Number (last 4 digits only): *

Trade Reference (Supplier) *

Contact Name & Phone *

Card Preferences

Requested Credit Limit: $ *

Number of Employee Cards Needed *

Authorized Users (list names): *

Payment Section

Sell Products *

Credit Card Application Fee

$49.99

common.payment.securePayments

Agreement & Authorization

I certify that all the information provided in this application is true and complete. I authorize the lender to obtain and verify credit history and financial information of the business and its guarantors. I understand that approval may require a personal guarantee.

Printed Name *

Signature *

Clear

Date Signed *