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5855 Obispo Avenue Long Beach, CA 90805
Tel: 562-602-3797 Fax: 562-602-3726
CONFIDENTIAL CREDIT APPLICATION (NEW / UPDATE ACCOUNT)
We welcome your interest in doing business with TA Chen Int’l. The extent to which this application is completed will assist us in determining the extend of a line of credit to your organization. All information submitted will be held in strict confidence and used solely for reference purpose within our company.
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LEGAL BUSINESS NAME:
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DBA:
PHONE:
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FAX:
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BILL TO ADDRESS:
ADDRESS:
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ADDRESS2:
CITY:
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STATE:
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ZIP:
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COUNTRY:
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Albania
Algeria
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Angola
Anguilla
Antigua
Argentina
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Aruba
Australia
Austria
Azerbaijan
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Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin Peoples Rep
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Djibouti
Dominica
Dominican Rep
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Is
Falkland Is
Fiji
Finland
France
French Guyana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar (UK)
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard Island & McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Micronesia
Minor Island
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peoples Rep Korea
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic Cameroon
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Pierre & Miguelon
San Marino
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Island
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Kitts and Nevis
St Lucia
St Vincent
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
São Tomé and Principe
Taiwan
Tajikistan
Tanzania
Thailand
Timor - Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks Caicos
Tuvalu
US Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Western Samoa
Yemen Republic
Zambia
Zimbabwe
SHIP TO ADDRESS:
the same as billing address above
ADDRESS:
*
ADDRESS2:
CITY:
*
STATE:
*
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
ZIP:
*
COUNTRY:
*
USA
Canada
Mexico
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin Peoples Rep
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Djibouti
Dominica
Dominican Rep
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Is
Falkland Is
Fiji
Finland
France
French Guyana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar (UK)
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard Island & McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Micronesia
Minor Island
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peoples Rep Korea
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic Cameroon
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Pierre & Miguelon
San Marino
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Island
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Kitts and Nevis
St Lucia
St Vincent
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
São Tomé and Principe
Taiwan
Tajikistan
Tanzania
Thailand
Timor - Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks Caicos
Tuvalu
US Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Western Samoa
Yemen Republic
Zambia
Zimbabwe
Business Information
APPLYING CREDIT LIMIT:
UPS ACCOUNT #:
UPS ZIPCODE
REFER FROM BRIGHTON-BEST INT’L:
*
YES
NO
null
HAVE YOU BEEN IN CONTACT WITH ANY TA CHEN SALESPERSON:
*
YES
NO
null
IF YES, SALESPERSON NAME:
BUSINESS TYPE:
*
PROPRIETORSHIP
PARTNERSHIP
CORPORATION
OTHER
IF CORPORATION, WHICH YEAR INCORPORATED
IF CORPORATION, WHICH STATE INCORPORATED
SIC CODE:
RELATED COMPANIES:
RELATIONSHIP:
YEAR ESTABLISHED:
*
UNDER PRESENT OWNERSHIP SINCE:
HOW MANY EMPLOYEES:
*
ESTIMATED ANNUAL SALES:
TYPE OF PRODUCTS ON CARRYING:
TYPE OF MATERIAL PURCHASED:
HOW DID YOU FIND OUT ABOUT TA CHEN INT'L:
FEDERAL TAX ID:
*
*(MUST PROVIDE PHOTO COPY OF FEDERAL TAX ID)
RESALES ID:
*
*(MUST PROVIDE PHOTO COPY OF RESALES ID)
Check here if your company resides at state which exempt from providing resale certificate.
DUN & BRADSTREET NO:
OWNER/ OFFICER
FULL NAME:
*
TEL:
*
FAX:
*
E-MAIL:
*
PAPERLESS BILLING
PRIMARY CONTACT:
FIRST NAME:
LAST NAME:
TITLE:
EMAIL:
BACK-UP CONTACT:
FIRST NAME:
LAST NAME:
TITLE:
EMAIL:
Check here if you will fax your own sheet of trade and bank reference lists
TRADE REFERENCE:
(AT LEAST THREE FROM WHOM PURCHASES ARE MADE ON A DIRECT CREDIT BASIS)
NAME:
*
TELEPHONE:
*
FAX:
*
BANK REFERENCES (MUST SIGN AND FAX THE AUTHORIZATION SECTION BELOW)
BANK NAME:
*
TITLE:
*
CONTACT NAME:
*
ACCOUNT NUMBER:
*
PHONE:
*
FAX:
*
YOUR INFOMATION
the same as owner/officer above
Your name:
*
Your E-Mail address:
*
Send me a copy of this report by email:
I HAVE READ, UNDERSTAND AND ACCEPT THE ABOVE TERMS AND HAVE PROVIDED TRUE INFORMATION TO THE BEST OF MY KNOWLEDGE. I FURTHER AUTHORIZE TA CHEN INT’L TO VERIFY ANY AND/ OR ALL REFERENCES GIVEN THAT MAY BE REQUIRED TO DETERMINE OUR CREDIT CAPABILITIES AND TO REQUEST RELEVANT INFORMATION FROM CREDIT REPORT AGENCIES. THIS AGREEMENT WAS MADE IN LONG BEACH, CA AND ANY DISPUTE OR LITIGATION RESULTING FROM THESE TRANSACTIONS WILL BE FILED IN THIS JURISDICTION. SHOULD IT BE NECESSARY TO REFER THE ACCOUNT BALANCE TO A LICENSED COLLECTION AGENCY OR ATTORNEY FOR LEGAL ACTION, APPLICANT AGREES TO PAY A 25% COLLECTION FEE, REASONABLE ATTORNEY FEES AND COURT COSTS.
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