Credit Reference Request Page

As a representative of my company, I agree to BCI's Terms & Conditions*
A "yes" response is required to proceed.
- Yes
Your Company's Name*
REQUIRED
Your Company's Address*
REQUIRED

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Name*
REQUIRED
First Last
Email*
REQUIRED
Phone*
REQUIRED
Please provide the company name from which you are seeking a trade reference*
REQUIRED

Customer Information
Please provide the following customer information.:
Company's Legal Name*
REQUIRED
DBA or Other Trade Name
Please provide if available.
Address*
REQUIRED

Street Address City State / Province / Region ZIP / Postal Code Country
Trade Experience
BCI has a "give-to-get" trade exchange policy. In order to obtain a trade reference, you must supply your experience.
Account Status*
REQUIRED
- Active
- New/No Experience or First Sale
- Inactive/No Recent Experience
- Not a Customer/Not Selling
Reason for Requesting a Reference*
REQUIRED
- Application for Credit Terms Pending
- Reapplyiing for Credit Terms
- Payment Trend Slowing
- Increased Exposure
- File Review
Aging Information
Current - Amount due within terms
REQUIRED; If application pending, enter 0.
1 - 30 Days beyond Terms (Past Due)
Please enter a value greater than or equal to 0.
31 - 60 Days beyond Terms (Past Due)
Please enter a value greater than or equal to 0.
61 - 90 Days beyond Terms (Past Due)
Please enter a value greater than or equal to 0.
91+ Days beyond Terms (Past Due)
Please enter a value greater than or equal to 0.
Total Balance*
REQUIRED: Total Amount Owed (will calculate)
Historical Sales Information
High Credit*
REQUIRED; if application pending enter 0
Please enter a value greater than or equal to 0.
Days Beyond Terms*
REQUIRED: Current days beyond terms (enter 0 if currently within terms or application pending)
First Sale Date
REQUIRED unless application pending
MM
DD
YYYY
Last Sale Date
REQUIRED unless application pending
MM
DD
YYYY

Business Credit Intelligence

Credit Reference Request

Step 1 of 3 - Credentials Page

Customer Information

Trade Experience

Aging Information

Historical Sales Information

Additional Details: