Internal Credit Submittals -

Company Name*
Customer ID*
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone Number*
Company Website

If you don't have a website leave it empty.
Origin Date*
Category*
Account Type*
- 1
- 2
- 3
Is this a Payroll Account?*
- Yes
- No
Account Manager*
Branch*
Prior Code (if applicable)*
Physical Work Location*
Work Done at Physical Location*
Job Titles to be Staffed*
Is 6’ social distancing being followed? If not, why?*
Are facemasks or face-coverings required?*
Are there additional cleaning / sanitation efforts being made as it relates to COVID19?*
Have you physically gone out to the client site and seen the work being done?*
- Yes
- No
Question/Comment*

Adel

Albemarle

Alma

Alpharetta

Anderson

Asheville

Atlanta South Metro

Boiling Springs

Buckhead

Burlington

Charleston

Charlotte

Cobb / Marietta

Columbia

Concord

Conyers

Dublin

Durham / RTP

Gaffney

Gainesville

Gastonia

Greenville

Gwinnett

Hickory

Jefferson

Lincolnton

Macon

Martinsville

Mayodan

McDonough

Mokena

Nashville Century Blvd.

Newberry

Newnan

Oxford

Rock Hill

Salisbury

Savannah / Pooler

Spartanburg

Statesboro

Troutman

Williamsburg / Newport News