Online Credit Application

Complete the form below or download PDF version to print, fill out and mail in.

CREDIT LINE REQUESTED:

INITIAL ORDER AMOUNT:

APPLICATION FOR ACCOUNT TERMS

Sales Agent:

Product Lines:

BUSINESS INFORMATION

Legal Business Name:

DBA Name:

Federal Tax ID #:

Street Address (No P. O. Box)

City, State, Zip, County

Rent     Own

Key Contact Name:

Phone:

Fax:

Contact Email Address:

A/P Email Address:

Web Address:

Year Business Established:

Years in Industry:

Number of Years Under Current Ownership:

Last Year Gross Sales:

Last Year Net Income:

Fiscal Year-end Date:

Do you have contents insurance coverage in the amount of requested credit line?

PRINCIPAL INFORMATION
(COMPLETE NAMES & STREET ADDRESS – NO P.O. BOXES)

First, Middle, Last Name

Home Address

City, State, Zip

Own     Rent

Title

Social Security #

Phone #

% of Ownership

First, Middle, Last Name

Home Address

City, State, Zip

Own     Rent

Title

Social Security #

Phone #

% of Ownership

First, Middle, Last Name

Home Address

City, State, Zip

Own     Rent

Title

Social Security #

Phone #

% of Ownership

BANK AND FINANCE COMPANY INFORMATION

Have you, your business or any officer, owner or principal previously
applied for credit with Onyx? Yes       No

Has the company and/or you, any owner, principal or officer ever filed for bankruptcy? Yes       No If yes, when?

Bank Name

Contact Name & Phone #

City, State

Checking Account #

Do you have a bank line of credit? Yes       No

Bank Line of Credit Line Amount

Floorplan Finance Company

Contact Name

City, State

Credit Line Amount

OPEN ACCOUNT REFERENCES (LIST YOUR TWO (2) LARGEST OPEN ACCOUNT VENDORS)

Vendor Name

Contact Name & Phone #

City, State

Account #

Vendor Name

Contact Name & Phone #

City, State

Account #

The above-named Applicant makes this application to Onyx Environmental Solutions, Inc. (or affiliates and/or subsidiaries "ONYX") for Account Terms and gives the above information to ONYX for this purpose. Applicant authorizes ONYX to obtain and investigate information concerning any statements made herein. I (or we, in the event that additional principals or potential guarantors execute this application by signing below) understand and agree that my (our) personal consumer credit report may be requested in connection with this application and any subsequent update, renewal, or extension of credit. If I (we) request, I (we) will be informed whether or not a credit report was requested and the name and address of the agency that furnished the report. If approved, Applicant authorizes ONYX to use any telephone, facsimile machine, computer or other device to send communications concerning ONYX programs to the Applicant. To the best of the knowledge of the undersigned, the information provided in this application is true and complete.