Credit Application Form

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ID 860.002.688-6

Credit Application Form and / or Data Update
For delivery to Corona Organization, verification, processing and disclosure control

TO START THE STUDY IS NECESSARY TO COMPLETE THIS FORMS IN FULL AND ATTACH THE REQUESTED DOCUMENTS

National Market

Export Market

1) Balance Sheet and Income Statement last 2 years ( to

1) Balance Sheet and Income Statement last 2 years (to

December 31st, audited and signed).

December 31, audited and signed).

2) Certificate of Existence and Legal Representation, maximum 2

2) Certificate of Incorporation of the company, maximum 2

month expedition.

month expedition. (equivalent document for each country)

4) Copy latest Income Tax or income certificate

3) Two Bank References

5) Copy of the Legal Representative ID

4) Two Trade or business References

Annual credit requested: $

Terms:

Date

Name of Company:
Acronyms and / or names used
Legal Representative name

In business since:

ID No.

-

Main Office Address
Business Website
Accounts Payable Contact Information:
BUSINESS INFORMATION( Please fill in full)
Main Activity description:

Phones :

Fax

City
E-mail
Phone:

Country

Operations: (in case of dealer please indicate whether wholesale or retail)
Brands, products or services offered main activity
Sold to :
Wholesalers
Retail
End USers
Other activities:
Purchased Products:
Sales territoty nationwide
Sales territory International level:
Customer number:
Nationwide
;Foreign
Sales Terms (
%) cash and (
%) credit with terms of (
) days
Other conditions (specify):
Employees Numbers: Administratives:
; Operating
Other facilities, plants, stores warehouses etc )

Link with Corona Organization

; Temporary;
Address:

Directly

TOTAL:
City

Indirectly

Which

SUPPLIER LIST ( Please relate the maximun number of suppliers- this information is relevant very important at the evaluation time of your request)
Company name
Phones
Contact Person
City
1
2
3
4
5
6
7
8
9
10

BANK REFERENCES
Bank Name
1
2
3
INSURANCES COMPANIES
Insurance Companies
1
2

Address, City, Country - Phone

Risk

Account Number

Insured Values

Properties
Real Estates Information

Mortgage: YES_____ NO______ Credit Card: YES_____ NO______
Vehicles:

Entity__________________________________________

OwnerShip Composition (Partners)
Name
Id
Percent ownership or control
1
2
3
4
5
6
The above information is for the purpose of obtaining commercial credit and is true, correct and complete.
Corona, or any credit bureau or other investigative agency retained by Corona, is hereby expressly authorized
to investigate the above references and other data obtained from Applicant or any other person pertaining to
Applicant’s credit worthiness or financial responsibility. Applicant’s signature attests to Applicant’s financial
responsibility, ability and agreement to pay Corona’s invoices in accordance with invoice and terms of sales
granted.

Signature
Legal Representative
ID N0.
EXCLUSIVE AREA TO BE COMPLETED BY THE ORGANIZATION CORONA
Business Concept

Commercial Agent: ____________________________________ Country : ______________________ Phones :_____________________



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Source Exif Data:

File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.3
Linearized                      : No
Page Count                      : 2
Producer                        : PrimoPDF
Create Date                     : 2011:02:11 21:15:20
Modify Date                     : 2011:02:11 21:15:20
Title                           : Credit Application Form (2).xls
Creator                         : PrimoPDF http://www.primopdf.com
Author                          : vrueda

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