Credit Application

Please complete the credit application form below. In addition to this application, you must send us your most recent two years of audited financial statements (Balance Sheet, Income Statement and Cash Flow Statement) and current interim statements. If it is unaudited, the respective owner/officer must sign and date each financial statement indicating the period covered by each statement.

You can send us this information via fax (1-303-939-8844, Attention Credit Department) or email (CreditCommittee@spectralogic.com).

Please email us at CreditCommittee@spectralogic.com if you have any questions or require assistance.

Fields marked with an asterisk * are required.


Company Information


Legal Company Name or Corporate Name: *

Doing Business As: *

Company Website Address: *

Company Form: *
Government EntityPrivate CorporationPublic CorporationPartnershipProprietorshipOther

Business Type: *
Value Added Reseller (VAR)Corporate ResellerOEMConsultantDistributorRetailEnd UserOther

Primary Customer Focus (if reseller):
Government/EducationEnterprise BusinessesSmall-Medium BusinessInternational/TradingOther

Year Business Started: *

Number of Employees: *

Last Month of Fiscal Year: *

Annual Revenue for Most Recent Fiscal Year: *

Profitable for Two Most Recent Fiscal Years: *

YesNo

Do You Have Audited Financial Statements? *

YesNo

Duns & Bradstreet Number:

Primary Company Phone: *

Mailing Address: *

City/Town: *

State: *

ZIP/Postal Code: *

Province/State: *

Country: *

Tax Exempt: *

YesNo

If yes, please submit applicable tax exemption/resale documentation to CreditCommittee@spectralogic.com.

Tax ID Number:

EIN #VAT #GST #Other Tax #

Parent Company Name (if you are a subsidiary):

Parent Company Phone (if you are a subsidiary)

Contact Information


Owner/CEO Name: *

Owner/CEO Phone: *

Owner/CEO Email: *

Accounts Payable Contact Name: *

Accounts Payable Contact Phone:*

Accounts Payable Contact Email:*

Finance Contact Name: *

Finance Contact Phone:*

Finance Contact Email:*

Bank Information


Bank Name: *

Bank Account Type: *

CheckingSavings

Bank Account Number: *

Bank Line of Credit:*

YesNo

If Yes, Line of Credit Account Number:

If Yes, Credit Limit:

Bank Contact Name: *

Bank Contact Phone: *

Bank Contact Email: *

Supplier 1 Credit Reference


Supplier 1 Company Name *:

Supplier 1 Accounts Receivable (AR) Contact Name *:

Supplier 1 AR Contact Phone *:

Supplier 1 AR Contact Email *:

Supplier 1 Account Number *:

Supplier 2 Credit Reference


Supplier 2 Company Name *:

Supplier 2 Accounts Receivable (AR) Contact Name *:

Supplier 2 AR Contact Phone *:

Supplier 2 AR Contact Email *:

Supplier 2 Account Number *:

Supplier 3 Credit Reference


Supplier 3 Company Name *:

Supplier 3 Accounts Receivable (AR) Contact Name *:

Supplier 3 AR Contact Phone *:

Supplier 3 AR Contact Email *:

Supplier 3 Account Number *:

Order Information


Currency of First Order: *

US DollarCanadian DollarEuroUK Pound SterlingAustralian Dollar

Estimated Amount of First Order (in US Dollars): *

Anticipated Annual Spectra Logic Purchases (in US Dollars): *

Name of Person Completing Credit Application:*

Title of Person Completing Credit Application: *

Date: (YYYY-MM-DD format)*

Notes/Comments About Your Credit Application: *

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