Flipbook TEST

CREDIT APPLICATION

FINE WINE + SPIRITS

REP NAME:

DATE:

BUSINESS INFORMATION

LICENSE #

EXP DATE

FED ID (EIN) #

WISD# (IL ONLY)

CORP

PARTNERSHIP

SOLE PROP

LICENSEE NAME

CHECK ONE

BUSINESS NAME

DBA:

CONTACT/OWNERSHIP INFORMATION

OWNER/APPLICANT

EMAIL

TITLE

PHONE

CELL

FAX

PAYABLE CONTACT

EMAIL

TITLE

PHONE

CELL

FAX

BILLING ADDRESS

CITY STATE ZIP

BANK INFORMATION PAYMENT TERMS:

FINTECH

ONLINE

CHECK BY MAIL

CHECK BY PHONE

ACH

BANK (NAME)

CONTACT

BANK PHONE CHECKING A/C# ROUTING#

BANK (ADDRESS)

CITY STATE ZIP

LANDLORD (NAME)

PHONE

LANDLORD (ADDRESS)

CITY STATE ZIP

CREDIT / TRADE REFERENCES

CREDIT REFERENCE #1 (NAME)

PHONE

ADDRESS

CITY STATE ZIP

CREDIT REFERENCE #2 (NAME)

PHONE

ADDRESS

CITY STATE ZIP

DELIVERY INFORMATION

SHIPPING ADDRESS

CITY STATE ZIP

NEAREST CROSSROAD

M

TU

W

TH

F

DAYS & TIMES DELIVERIES CAN BE ACCEPTED: DAYS:

START TIME: END TIME:

SPECIAL INSTRUCTIONS

BUSINESS HOURS: OPEN TIME: CLOSE TIME:

SALES DATA

AFFILIATED BUSINESS NAMES (LIST ALL):

ESTIMATED MONTHLY PURCHASES: $ CREDIT LIMIT NEEDED: $ TERMS REQUESTED

HISTORIC SALES: TWO-YEARS AGO: $ LAST YEAR: $ YEAR-TO-DATE: $

COMPOSITION OF SALES (TOTAL 100% ) BEER % WINE % SPIRITS % OTHER %

FACILITIES: NUMBER OF LOCATIONS: ON OFF TOTAL SQUARE FEET BONDED AREA

WHICH BEST DESCRIBES YOUR BUSINESS?

RESTAURANT

RETAIL SHOP

GROCERY

WAREHOUSE

DISTRIBUTOR