Adinaline Business Credit Application

Approval takes approximately 1-2 weeks. First orders must be placed via credit card. Payment terms will be created based on the results of your application.

Section 1 - Business Contact Information

Company Name

Position Title

DUNS #

Phone

Fax

Street Address

City

State

Zip Code

Date Business Commenced

Business Type

Sole Proprietorship Partnership Corporation Other

Section 2 - Business and Credit Information

Business Street Address

City

State

Zip Code

Time at Current Address

Telephone

Fax

Bank Name

Bank Address

Type of Account

Business Checking Savings Other

Account Number

Section 3 - Business / Trade References

Reference 1

Company Name

Address

Type of Account

Telephone

Fax

Reference 2

Company Name

Address

Type of Account

Telephone

Fax

Section 4 - Acceptance / Submission

By submitting this application, I agree to the following terms: Payment is due 30 days from date of invoice. Claims must be made within 7 days of receipt of goods. I authorize Adinaline, LLC to make inquiries into the business and credit information provided in this application.