Adinaline Business Credit Application

Please fill out the credit application on this page. Approval will take approximately 1-2 weeks time. Please note that all first orders must be placed via credit card. From there, payment terms will be created depending on your results from the application. Thanks so much for visiting us and we look forward to our future business relationship!

Business Contact Information

COMPANY NAME:

POSITION TITLE:

DUNS #:

PHONE:

FAX:

EMAIL:

STREET ADDRESS:

CITY:

STATE:

ZIP CODE:

DATE BUSINESS COMMENCED:

BUSINESS TYPE:

Sole Proprietorship Partnership Corporation Other

Business and Credit Information

BUSINESS STREET ADDRESS:

CITY:

STATE:

ZIP CODE:

TIME AT CURRENT ADDRESS?:

TELEPHONE:

FAX:

EMAIL:

BANK NAME:

BANK ADDRESS:

TYPE OF ACCOUNT:

Business Checking Savings Other

ACCOUT NUMBER:

Business / Trade References

COMPANY 1 NAME:

COMPANY 1 ADDRESS:

TYPE OF ACCOUNT:

TELEPHONE:

FAX:

EMAIL:

COMPANY 2 NAME:

COMPANY 2 ADDRESS:

TYPE OF ACCOUNT:

TELEPHONE:

FAX:

EMAIL:

Acceptance / Submission

1. All invoices are to be paid 30 days from the date of the invoice.

2. Claims arising from invoices must be made within seven working days.

3. By submitting this application, you authorize Adinaline, LLC to make inquiries into the banking and business / trade references that you have submitted for approval.

Please verify that all of the information has been filled out and is accurate. Click the submit button below to send your credit application over to us. Please call or email with any questions and/or concerns. Thanks!