***In addition to submitting your form online: Please fill out, print out & sign and fax back to 812-923-6422 ***
Applications must be signed before any account will be set up.
Smith Creek Logo

CREDIT APPLICATION FOR A BUSINESS ACCOUNT

BUSINESS CONTACT INFORMATION

Name:* Title:*
Company Name:*
Phone* Fax:* E-mail:*
Company Address:*
City:* State:* ZIP Code:*    
Date business commenced: (Ex. 01/01/1990)
Sole proprietorship:        Partnership:        Corporation:           Other:  
 

BUSINESS AND CREDIT INFORMATION

Amount of credit requested:*
How long at current address? Loan Officer: Loan #:    
Federal Tax ID number:*            
Telephone: Fax: E-mail:
Bank name:
Bank address: Phone:      
City: State: Zip:    
Type of account Account number
Savings        
Checking        
 

BUSINESS/TRADE REFERENCES

Company Name:*            
Address:*            
City:* State:* Zip:*    
Phone:* Fax: E-Mail:    
Type of account:            
Company Name:            
Address:            
City: State: Zip:    
Phone: Fax: E-Mail:    
Type of account:            
Company Name:            
Address:            
City: State: Zip:    
Phone: Fax: E-Mail:    
Type of account:            

TERMS AND CONDITIONS

A Copy of the applicant’s recent Balance Sheet and Annual Operating Statement is attached to this Credit Application for credit lines
in excess of $10,000.

If approved, open account terms are Net By 30 days from invoice date. A service charge of 1 ½% per month is charged on invoices
not paid by the 15th. Sales tax will be charged on each invoice unless a properly completed sales tax exemption form is on file.
Prices are subject to change without notice. Customer agrees to pay all legal and collection costs, including court costs involved in
collecting any portion of an unpaid balance.

My digital signature authorizes Koetter & Smith, Inc. to contact the references listed above and I agree to the above terms and conditions.

I confirm my understanding that misuse, (either negligent or intentional), and/or fraudulent use of this certificate may subject both me personally
and/or the business entity I represent to the imposition of tax, interest, and civil and/or criminal penalties.
Name of Applicant* Date*
    Title*
           

***In addition to submitting your form online: Please fill out, print out & sign and fax back to 812-923-6422 ***
Applications must be signed before any account will be set up.