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Credit Application
tricirclecorp
2025-04-30T09:17:50-04:00
Credit Application
Business Name
(Required)
Website
Phone
(Required)
Email
(Required)
Enter Email
Confirm Email
Address
(Required)
Street Address
City
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Different address for Billing?
(Required)
Yes
No
Billing Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
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Maine
Maryland
Massachusetts
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Minnesota
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Northern Mariana Islands
Ohio
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
D/B/A
Federal Tax I.D Number
Does your company have a parent company?
(Required)
Yes
No
Parent Company Name
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Type of Business
Date Established
MM slash DD slash YYYY
Does State/County require a License?
Yes
No
If Yes, License #
(Required)
Company Status
Sole Proprietorship
Partnership
Corporation
LLC
LLP
Principle
First
Last
Title
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Trade Reference (Name suppliers of major product and services)
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Initials
(Required)
Bank References
Checking
Loan
Savings
Bank
Name
Address
Account #
Contact
Line of Credit Requested $
No. Employees
Est. Annual Sales $
Sales Territory
Has the firm or any of its Principals ever been bankrupt?
(Required)
Yes
No
If yes, please explain why:
(Required)
Person to Contact About Account
(Required)
Name
Title
Phone
Email Address
Personal Credit Release
By signing this application, I authorize TriCircle or its agency to investigate my personal credit and financial records. As part of such investigation, I authorize TriCircle Pavers to request and obtain consumer credit reports on me in connection with the opening, monitoring, renewal and extension of this and other accounts with TriCircle Pavers and the marketing of other products and services to me and my business by TriCircle Pavers. I further authorize TriCircle Pavers to share the information received from my consumer credit report with TriCircle Pavers, parent, subsidiaries and affiliates (and others if applicable). If I request, you will tell me whether my consumer credit report was requested and if so the name and address of the consumer credit agency that furnished the report. Any misrepresentation in this application will be considered evidence of a fraud, since this information is the basis of the granting of credit. As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references listed.
Title
(Required)
Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Signature
(Required)
Initials
(Required)
Personal Guarantee
In consideration of credit being extended by TriCircle Pavers to the above named applicant for product or service whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation or any other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to TriCircle Pavers the faithful payment, when due, of all accounts of said applicant for the purchases made within five years after the date of this application. Individual guarantors herein agree to pay upon demand all costs and expenses of collection, including but not necessarily limited collection fees and/or attorney fees herein fixed at 30% of the amount sought for collection, together with interest on the outstanding principle balance at the rate of 18% per annum or 1.5% per month on any and all invoices in accordance with the terms therein. The undersigned guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by TriCircle Pavers extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Absent written permission by creditor, this personal guarantee may not be revoked.
Title
Name
First
Last
Date
MM slash DD slash YYYY
Signature
Personal Guarantee
(Required)
Yes
No
Initials
(Required)
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