subject_line
CUSTOMER CREDIT APPLICATION
CUSTOMER ACCOUNT
Business Type
*
Corporation
LLC
Government
Partnership
Sole-Proprietor
Company Legal Name
*
DBA:
Legal Physical Address
*
Address 2
City
*
Country:
*
Austria
Canada
France
Germany
Italy
UK
United States
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Province
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip Code
*
Tax ID
*
Social Security Number (SSN)
*
Has the Applicant of affiliate had a UATP Account with United or any other issuer?
Yes
No
Account Number
CREDIT REQUEST
Credit Limit Requested
*
Estimated Monthly Spend