launch 3 logo
Credit Application for a New Business Account
  • Launch 3 Ventures, LLC
  • 27 Daniel Road West, Fairfield, NJ 07004
  • Phone: (877) 878-9134
Business Information
Company Name:
Mailing Address:
Phone & Fax:
Phone:
Fax:
AP Contact Info:
Name:
Title:
Phone:
Email:
Credit Requested:
Credit limit requested: $
Amount of initial order: $
Type of company: only 1 can be selected
Bank Information
Bank Name:
Bank Address:
Bank Phone & Acct #:
Phone #:
Acct #:
Authorized Officer:
(list additional officers on separate page)
Title:
Phone #:
Business References - complete all info
Company Name:
Contact:
Address:
Phone & Fax:
Phone #:
Fax #:
Type of acct & number:
Type of acct:
Acct #:
Company Name:
Contact:
Address:
Phone & Fax:
Phone #:
Fax #:
Type of acct & number:
Type of acct:
Acct #:
Company Name:
Contact:
Address:
Phone & Fax:
Phone #:
Fax #:
Type of acct & number:
Type of acct:
Acct #:

I hereby certify that the information provided on this form is complete and accurate and has been furnished with the understanding that it is to be used to determine the amount and conditions of credit extended. I authorize the institutions listed above to release necessary information to the company for which credit is being applied in order to provide references and verify the information contained herein. Furthermore, I understand that the processing time for this application averages between 3 and 5 business days and that until approved any orders will be on a pre-paid basis.

Signature

Title

Date