Online Credit Application:

Please fill out the form below or you can download this online credit application form and send it by mail to the following address:

1403 Piedmont Hwy
Piedmont, SC 29673
PH:864-277-7272
FX:864-277-7277
Firm Name:
Contact Person:
Address:
City:
State:
Zip:
Business Type:
Year Business Opened:
Federal ID#:
Principals Name:
Your Email:

Bank Reference:
Name:
Account Number:
Address:
City:
State:
Zip:
Phone:
Date account opened:

Trade References:
Firm Name:
Phone:
Firm Name:
Phone:
Firm Name:
Phone:
   
The undersigned herby agrees to our terms of "NET 30 DAYS" and should a credit account be opened, and 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 on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

Company:

Date:
Title:
Please Print Your Name: