Credit Application

Customer Status

Are you an existing Soligent customer with an account number?

Yes No

Select whether you've completed the dealer application and received your account number.

Business Mailing Address

Address Line 1:

Enter your street address, P.O. box

Address Line 2: Please enter your suite, unit, building, floor, if applicable

City Enter your city

Zip: Enter your zip or postal code

State Select your state

Country Select your country

Taxpayer Identification Number (TIN)

TIN Type:

Social Security Number Employer Identification Number Other (International Company)

Select the appropriate type of TIN for your company

Business Details

Entity Type Select your business's entity type

Business Domicile State Select the state the business is domiciled or established in

Year Business Established: Enter the year your business was established

Contractor's License Number: Enter your contractor's license number

Contractor's License State Select your license state

Contractor's License Type: Enter your license type

Resale Certificate Number: Enter your resale certificate number, if applicable

Accounts Payable Details

A/P Contact First Name: Enter your company's A/P contact's first name. If you do not have a designated A/P contact, please put down "Accounts" for the first name and "Payable" for the last name.

A/P Contact Last Name: Enter your company's A/P contact's last name. If you do not have a designated A/P contact, please put down "Accounts" for the first name and "Payable" for the last name.

A/P Phone: Enter your company's A/P phone.

A/P Email: Enter your company's A/P email.

Verify A/P Email Please verify your company's A/P email.

Financial Details

Annual Sales (US$): Enter your most recent annual sales number

Requested Credit Limit (US$): Enter your requested credit limit

Year of Latest Copy of Financial Statement: Enter the year of the latest copy of your financial statement. If you do not have financial statements, list the most recent year of your annual sales figures

Financial Statement Is Audited:

Yes No

Select whether your latest financial statement is audited

Trade Reference Information

List only firms with whom you have open and active credit accounts. Please enter your trade references details as accurately as you can - this will assist greatly in determining the level of credit that we can extend. You can add trade references by cicking the "Add Trade Reference" button.

Add a Trade Reference

Bank Reference Information

Please enter your bank references details as accurately as you can - this will assist greatly in determining the level of credit that we can extend. You can add bank references by cicking the "Add Bank Reference" button.

Add a Bank Reference

1. Client Information

Your Information

First Name:

Last Name:

Title:

Email:

Are you a principal, owner, partner or director of this company?:

2. Company Information

Soligent Account Number:

Company Name:

DBA:

Business Phone:

Business Fax:

Mailing Address

Address Line 1:

Address Line 2:

City:

City

State:

Country:

3. Business & Credit Information

Taxpayer Identification Number (TIN) Details

Tin Type:

TIN:

Business Details

Entity Type:

State Domiciled In:

Year Established:

Contractor License Details:

Resale License:

Accounts Payable Details

A/P Contact First Name:

A/P Contact Last Name:

A/P Email:

A/P Phone:

Financials & Credit Request

Credit Limit Requested:

Annual Sales:

Financial Statement Year & Audit Status:

4. Additional Business Principal Information

Owners, Partners, Directors & Officers

Bankruptcies & Judgement/Liens

Bankruptcy Details, if any:

Judgement Details, if any:

5 & 6. Trade & Bank References

Trade References

Bank References

Additional Notes/Comments: Enter any additional information that you'd like to include in this application

Once this application is submitted, you will be receiving a secure email from Docusign to electronically sign this credit application.

Click here to indicate that you acknowledge that this application is not completed until it is electronically signed through Docusign.

New Credit Application

Customer Status

This application is only for existing Soligent customers

Your Information

Company Information

Business Mailing Address

Taxpayer Identification Number (TIN)

Business Details

Accounts Payable Details

Financial Details

Business Principal Information

Trade Reference Information

Bank Reference Information

Your Information

Mailing Address

Taxpayer Identification Number (TIN) Details

Business Details

Accounts Payable Details

Financials & Credit Request

Owners, Partners, Directors & Officers

Bankruptcies & Judgement/Liens

Trade References

Bank References