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Employer Application for Credit

Mandatory information required in order to extend credit.
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Labor Temps-THE STAFFING COMPANY   |  Mesa (480) 835-3001 |  (480)969-7009

Applicant Information
First Name:
Last Name:
Company:
SS#:
EIN#:

Select One: 

Corporation
  Partnership
  Sole Proprietor
  Other
Bill Rate $:  (estimated for Credit Purposes)
Annual Sales $:
# of Years in Business:
SIC Code:
  Yes, Purchase Orders Are Required.

If yes, how often?:

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Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
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Job #1 Description of Duties:
Equipment Needed:
W/C Code:
Approx. # of Employees per Day:
Bill Rate $:
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Job #2 Description of Duties:
Equipment Needed:
W/C Code:
Approx. # of Employees per Day:
Bill Rate $:
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Site Address + Site Directions + Travel time:
Co-Applicant Information
First Name:
Last Name:
Contact Information
Daytime Phone:
Evening Phone:
Email:
Financial Information
Bank Name:
Bank Address:
City/State/Zip:
Bank Phone #:
Account #:
Date Opened:
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Loan Bank:
Address:
City/State/Zip:
Bank Phone:
Account #:
Date Opened:
Trade References
Company:
Contact:
Address:
City/State/Zip:
Telephone:
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Company:
Contact:
Address:
City/State/Zip:
Telephone:
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Company:
Contact:
Address:
City/State/Zip:
Telephone:
Other Information
Comments:
I hereby certify that the information in this credit application is correct.  Labor Temps and/or its agents are authorized to make investigations of our/my credit.  The information provided will enable Labor Temps to determine the amount of credit and the conditions under which credit will be extended. I authorize the bank and trade reference listed above to release credit information on the company. Starting 30 Days after invoice date, interest will accrue at a rate of 1.5% per month or the highest amount allowed by law.  In any dispute concerning this agreement, the prevailing party will be entitiled to recover its legal fees and expenses.