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Credit Application Form
To print and fax a PDF version, click here.


 Company Information
     
Company Name:  
Phone #:  
Address:  
Fax #:  
City:  
State/Prov:  
Postal/Zip:  
Fed Tax ID: (US only)  
DUNS Number:  
     
 Purchaser's Contact Information
     
Name:  
Phone #:  
E-mail Address:  
Fax #:  
     
 Billing Information if Different from Above (Where invoices should be mailed)
     
Bill to Address:  
City:  
State/Prov:  
Postal/Zip:  
A/P Contact Name:  
Phone #:  
E-mail Address:  
Fax #:  
     
 Ship to Information
     
 Location #1:
 
Ship to Address:  
City:  
State/Prov:  
Postal/Zip:  
Receiving Hours:  
Appointment Needed:  

Shipping Contact Name:  
Phone #:  
E-mail Address:  
Fax #:  
     
 Location #2:
 
Ship to Address:  
City:  
State/Prov:  
Postal/Zip:  
Receiving Hours:  
Appointment Needed:  

Shipping Contact Name:  
Phone #:  
E-mail Address:  
Fax #:  
     
 Banking Information
     
Bank Name:  
Acct #:  
City:  
State/Prov:  
Postal/Zip:  
Bank Contact Name:  
Tel #:  
E-mail Address:  
Fax #:  
     
 Trade References
 
 Vendor #1 - Contact Information
 
Vendor Name:  
Tel #:  
City:  
State/Prov:  
Fax #:  
Contact:  
E-mail Address:  
     
 Vendor #2 - Contact Information
 
Vendor Name:  
Tel #:  
City:  
State/Prov:  
Fax #:  
Contact:  
E-mail Address:  
     
 Vendor #3 - Contact Information
 
Vendor Name:  
Tel #:  
City:  
State/Prov:  
Fax #:  
Contact:  
E-mail Address:  
     
 Credit Policy
 
Payment terms are 30 days from date of invoice. All delinquent accounts that remain unpaid beyond 15 days past due date will be placed on "Credit Hold". While an account is on Credit Hold no orders will be shipped until past due invoices are remedied. Accounts over 30 days past due will be placed on COD. If an account is consistently over 30 days past due &/or on Credit Hold, it will be placed on COD permanently.
     
Name of Corporate Officer/Owner/Partner:
 
Date: Title:
     
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