Credit Application Step 1 of 5 20% Name*Company Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneCompany Voice Phone NumberFaxPlease enter Company FAX NumberWebsite*Please enter Company Website URL (https://xx.com) Business Type*Please enter Type of Business Sole-Proprietorship Partnership Limited Liability Incorporated State of IncorporationIf Business type is Incorporated then enter State of Incorporation Tax ID*Please enter Tax ID number or VAT number Years in Business*Please enter Number of years conducting businessPrincipal*Please Enter names of Principal officers like Owner, President, or Vice President. Prior Year Revenue*Please enter last tax years revenueAP Manager Contact*Please Enter Name of Manager in charge of Accounts Payable. First Last AP Email*Email where Videx sends Invoices AP Phone*Phone number for Videx to contact AP to resolve payment issues.AP FAX PhonePhone number for FAX communications. Note: Videx prefers EmailsRequire PO for Orders*Do you require a purchase order number before Videx accepts an order? Yes No Banking Reference*Please enter your Primary Bank information Bank Name Branch Bank Contact Name*Please enter your Primary Bank Contact Name First Last Bank Contact PhonePlease enter your Primary Bank Contact Phone numberBank Email Please enter your primary Bank Contact EmailBanking 2 ReferencePlease enter your Optional Bank information Bank Name Branch Bank 2 Contact NamePlease enter your Optional Bank Contact Name First Last Bank 2 Contact PhonePlease enter your Optional Bank Contact Phone numberBank 2 Email Please enter your Optional Bank Contact Email Trade Reference 1*Please enter Company Name & address, Contact Name, Contact Phone Number, Contact Email and Contact Fax NumberTrade Reference 2*Please enter Company Name & address, Contact Name, Contact Phone Number, Contact Email and Contact Fax NumberTrade Reference 3*Please enter Company Name & address, Contact Name, Contact Phone Number, Contact Email and Contact Fax NumberTrade Reference 4Please enter Company Name & address, Contact Name, Contact Phone Number, Contact Email and Contact Fax NumberAgreement*Applicant hereby warrants that the information given in this Application for Credit is complete and accurate. Applicant understands that Videx will rely and act upon the information provided in determining the amount and conditions of credit to be extended to Applicant. Applicant authorizes Videx to conduct an investigation into Applicant’s credit worthiness including, but not limited to, obtaining commercial and consumer credit reports, trade references, lender references and lease references. Further, Applicant hereby authorizes the financial institutions listed in this Application for Credit to release information to Videx as necessary in order to verify the information contained herein. These credit terms are subject to Videx’s continued approval. Subject to compliance with all applicable laws, Videx may, in its sole discretion, deny credit to Applicant or increase, decrease, or terminate Applicant’s credit availability at any time and for any reason without prior notice to Applicant. Invoices must be paid in full within thirty (30) days from the date of invoice. Yes, I Agree No, I don’t Agree PhoneThis field is for validation purposes and should be left unchanged.