Business Credit Reports

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Company Information

Company Name

Address

City

State/Province

Zip/Postal Code

Country

Phone

Website

Legal Form (Corporation, Partnership, or Proprietorship)

Tax Identification #

Contact Information

First Name

Last Name

Title

Phone

Fax

Accounts Payable Contact Information

Name

Phone

Bank Information

Bank Name

Address

City

State

Zip

Phone

Fax

Account #

Financial Contact

Request

Requested Amount

Comments (400 characters max)

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By clicking 'Submit', I/We authorize Adagio Teas or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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