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Credit Application

Fill out the form below and we'll review your application. All fields marked * are required.

Business Information

Firm Name*

Trade Style

Street Address*

Phone*

City*

State*

Zip*

Owner / Debtor

Full Name of Owner / Authorized Officer*

Debtor (Individual signing contract)*

SS#

Business Type *

Filed Bankruptcy?

Fed Tax No (if Corporation)

Business Details

Type of Business*

Date Established*

Estimated Annual Sales

Location

Former Business

Liquor License #

Own or Rent Building

Landlord

Property Value

Mortgage Co.

Trade References

Ref 1 Name

Address

Phone

Ref 2 Name

Address

Phone

Ref 3 Name

Address

Phone

Ref 4 Name

Address

Phone

Bank Information

Bank Name*

Account Number

Bank Street Address

Bank Phone

Bank City

Bank State

Bank Zip

Guarantors

Guarantor 1 Name

Guarantor 2 Name

Terms & Conditions

Payment Terms: Any payment not received as specified by the invoice terms will be considered PAST DUE. A finance charge of 12% per annum will be charged on overdue accounts.

Non-Payment: London Manhattan Corp. reserves the right to repossess all products due to non-payment and will give credit to customers for any salvage value.

Invoice Deductions: Absolutely NO deductions from invoice amount will be allowed without prior approval from London Manhattan Corp.

Returned Check Policy: Customers will be charged a $35 fee for any returned checks.

Should collection procedures become necessary, the applicant agrees to pay all court costs, attorney fees, and collection agency fees.

Applicant Signature

Applicant Name*

Title*

I/We have read and understand the above Terms and Conditions and agree to abide by them. I/We authorize London Manhattan Corp. to inquire as to the status of banking relations and obtain a business credit report as part of the credit evaluation process.