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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.
*Required 
Customer Type: *    
LEGAL BUSINESS NAME: *   
DBA: 
PHONE:*    FAX:*   
 
BILL TO ADDRESS:
ADDRESS:*     ADDRESS2: 
CITY:*  STATE:* 
 ZIP:*   COUNTRY:* 
SHIP TO ADDRESS:    the same as billing address above
ADDRESS:*  ADDRESS2: 
CITY:*   STATE:* 
 ZIP:*   COUNTRY:* 
 
Business Information
APPLYING CREDIT LIMIT:
UPS ACCOUNT #:
UPS ZIPCODE
REFER FROM BRIGHTON-BEST INT’L:*   
HAVE YOU BEEN IN CONTACT WITH ANY TA CHEN SALESPERSON:*   
   IF YES, SALESPERSON NAME:  
BUSINESS TYPE:*   
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)
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:
 
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: *  
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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