Credit Application

Business Information

Business Name*

Business Address*

City/State/Zip*

Business Phone

Contact Email

Business Type

CorporationPartnershipSole PropIndividual

Federal Tax Id#/ Social Security #

Owner Information

Owner Name

Title

Accounts Payable Information

AP Contact*

AP Address*

AP City/State/Zip*

AP Phone*

AP Email*

PO Required?*

YesNo

Additional Information

Have you ever filed bankruptcy?

YesNo

If Yes, What type & when?

Are You Tax Exempt?

YesNo

If yes, please upload your tax exemption

Insurance Certificate (If Applicable)

Any Other Attachments Applicable


The above information is represented to be true and correct and has been provided to ProBox for the purpose of extending credit to the applicant. ProBox is hereby authorized to contact and make any and all inquiries from available references, banks and sources provided above. Any information provided or obtained as a result of this Application for Credit will be kept confidential and used only to evaluate the Applicant’s credit worthiness. The applicant agrees to pay any and all accounts according to the terms listed on the invoice/contract. If no terms are listed, the applicant agrees to pay the account charges within 10 days of presentation of any invoice/billing. It is further understood and agreed if amounts owed are not paid when due, the applicant will pay all ProBox’s collection costs, reasonable attorney fees, court costs and an 18% interest rate per year, calculated on a daily basis on all charges owed. It is agreed that in the event of any litigation, the venue will be in Maricopa County, Arizona.

Sign*:

Date*: