Credit Application

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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 Intâ€™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: *

New

Re-activate

Increase Credit Line

LEGAL BUSINESS NAME: *

Business Name: Required

DBA:

PHONE:*

Phone: Required

FAX:*

Fax: Required

BILL TO ADDRESS:

ADDRESS:* ADDRESS2:

CITY:*

STATE:*

State: Required

ZIP:*

COUNTRY:*

SHIP TO ADDRESS: the same as billing address above

ADDRESS:* ADDRESS2:

CITY:*

STATE:*

Ship to State: Required

ZIP:*

COUNTRY:*

Ship to Country: Required

Business Information

APPLYING CREDIT LIMIT:

UPS ACCOUNT #:

UPS ZIPCODE

REFER FROM BRIGHTON-BEST INTâ€™L:* YESNO Refer from Brighton-Best: Required

HAVE YOU BEEN IN CONTACT WITH ANY TA CHEN SALESPERSON:* YESNO TA CHEN Salesperson: Required

IF YES, SALESPERSON NAME:

BUSINESS TYPE:*

Business Type: Required

IF CORPORATION, WHICH YEAR INCORPORATED

IF CORPORATION, WHICH STATE INCORPORATED

SIC CODE:

RELATED COMPANIES:

RELATIONSHIP:

YEAR ESTABLISHED:*

UNDER PRESENT OWNERSHIP SINCE:

Ownership: Numeric Value

HOW MANY EMPLOYEES:*

Number of Employee: Required

ESTIMATED ANNUAL SALES:

TYPE OF PRODUCTS ON CARRYING:Maximum 1000 characters

TYPE OF MATERIAL PURCHASED:Maximum 1000 characters

HOW DID YOU FIND OUT ABOUT TA CHEN INT'L: Maximum 1000 characters

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:*

Owner Name: Required

TEL:*

Owner Phone: Required

FAX: *

Owner Fax: Required

E-MAIL:*

Owner Email: Required

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:*
			Trade Reference: Required Trade Phone: Required Trade Fax: Required
			Trade Reference: Required Trade Phone: Required Trade Fax: Required
			Trade Reference: Required Trade Phone: Required Trade Fax: Required

BANK REFERENCES (MUST SIGN AND FAX THE AUTHORIZATION SECTION BELOW)

BANK NAME:*	TITLE:*	CONTACT NAME:*	ACCOUNT NUMBER:*	PHONE:*	FAX:*
Bank name: Required		Bank Contact: Required	Bank Account: Required	Bank Phone: Required	Bank Fax: Required

YOUR INFOMATION

the same as owner/officer above

Your name: *

Your E-Mail address: *

Your Email Address: Not a vaild email 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 INTâ€™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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