Dai Cheong Trading Company, Inc.
317 NORTH AVENUE 19 - LOS ANGELES, CA 90031
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PHONE (323)225-1888   FAX (323)225-9080    
CREDIT APPLICATION FORM
Dai Cheong Trading Company, Inc. - 317 N. Avenue 19th Los Angeles, CA 90031
Telephone (323) 225-1888 - Fax (323)225-9080

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Firm Name

Business Address

City

State

Zip Code

Business Phone

Fax 123-123-1234

Business Email

Years in Business

Resale number


Ownership Select One
Corporation
S Corp
Partnership
Sole Proprietorship
Other Ownership. If none, type "NA"
Corporation ID. No.

State Account No.

Description of Business


Home Address

City

State

Zip Code

Home Phone

Social Security No.


Trade References: Only those you buy from an open account in California
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Address 1

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CREDIT REFERENCES
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Address 1

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Zip Code 1

Contact Name 1

Phone 1

Reference 2

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Zip Code 2

Contact Name 2

Phone 2

Bank Name

Bank Branch

Bank Address

Bank City

Bank State

Bank Zip Code

Account Type

Account Number

Bank Phone or Fax

How long with this bank?


Do you pledge or borrow on your Account Receivable to anyone?
Yes
If yes, from Whom? If no type "NA" No

Real Estate Owned Address
City
State
Zip Code
Name of Mortgage on Real Estate
Mortgage Loan No.
Property Value $
Mortgage on Machinery or Equipment
Equipment Value $
Insurance carried Name(SPECIFY)
Policy No.

This application must be filled out fully in order for it to be processed.
By filling out and submitting the information below you are giving your digital authorization as follows
I/We represent the above information is correct to the best of my/our knoledge and I/We intend it to be relied upon for the purposes of this application.
I/We authorize DAI CHEONG TRADING CO., INC. to make any inquiries it considers necessary and appropriate concerning such information.
NAME OF FIRM

AUTHORIZED BY

COMPANY TITLE

DATE dd/mm/yyyy

Dollar amount requesting $

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