CREDIT APPLICATION | Allentown Optical

Application for Credit

Please fill out the below form in its entirety to be considered for a credit approval. Our credit manager will notify you of your approval in a timely manner. All information provided will be held in strictest confidence.

FIRM INFORMATION

Name of firm or individual

Street address

City

State

ZIP

Area code

Phone

Years at this address

OWNERSHIP

Ownership typeCorporationPartnershipIndividualIncorporated in past 12 months

Name of Principal 1

Street address

ZIP

Phone

Name of Principal 2

Street address

ZIP

Phone

Name of Principal 3

Street address

ZIP

Phone

Name of Principal 4

Street address

ZIP

Phone

FINANCES

Bank

Bank Phone

Bank officer or department

Bank address

REFERENCES

Business name

Phone

Business address

Second business name

Phone

Business address

Third business name

Phone

Business address

Fourth business name

Phone

Business address

Are cash sales okay until credit is approved?
YesNo

How did you hear about Allentown Optical?*

We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

Electronic signature:

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