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P.O. Box 1050, 1401 South Broadway Red Lodge, MT 59068 USA 800-331-0304 or 406-446-3446 website www.crazycreek.com Fax 406-446-1411 email [email protected]
C R E D I T A P P L I C A T I O N
Please fill out completely to qualify for terms. If you are prepaying with credit card only, please fill out the portion above Bank References and sign the bottom of the form .
Business Name _________________________________________________ DBA or Division ________________________________________
Mailing Address ________________________________________ City, State, Zip ________________________________________________
Shipping Address_______________________________________ City, State, Zip _________________________________________________
Business Phone ____________________________________________ Business Fax _______________________________________________
Buyer/Order Contact ______________________________________ Buyer Phone ______________________________________________
Buyer email ________________________________________________ Website ___________________________________________________
Nature of Business (ex. Specialty Sporting Goods) _______________________________________________________________________
Date Opened __________________ Circle One Corporation Partnership Sole Proprietorship Non-Profit
Fed Tax ID No._________________________________ Amount of Credit Requested ___________________________________________
Name of Owner/Officer_______________________________ Title ____________________________________________________________
A/P Contact _____________________________ A/P Phone __________________________________ A/P Fax _______________________
Bank Reference:
Bank Name___________________________________________________ Phone _________________________________________________
Address ___________________________________________City, State, Zip______________________________________________________
Contact Name ______________________________________________ Account No. ____________________________________________
Dun & Bradstreet No.___________________________________________
Business References: Fax numbers must be up to date as we contact your references by fax. We require 3 favorable
references to assign terms. Listing incomplete or incorrect references may result in prepay terms only.
Name ___________________________________________Address _____________________________________________________________
City, State, Zip__________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address _____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address _____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address _____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address _____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Applicant agrees to financial responsibility, ability and willingness to pay our invoices in accordance with our terms
Credit Net 30 Days/$200 minimum opening order. In the event that a delinquent account is placed in the hands of a
licensed collector or attorney for collection on the account, in addition to the amount of the delinquent account the
applicant shall pay all costs and any reasonable collector's or attorney's fee. A finance charge of 1.5% per month will be
assessed on all unpaid balances.* Initial order must be prepaid before qualifying for terms.
Applicant certifies that the above information is true and correct.
Applicant’s Authorized Signature _________________________________________________________ Date________________________
Print Name ________________________________________________Title ________________________________________________________
