Credit Account Application

Bold fields are required.

Business Type: Sole Proprietorship Partnership Corporation - In the State of:

Number of years in business

Phone:

Fax:

Company Name:

Address:

City:

State:

Zip/Postal Code:

Country:

Contact Details Name and address of individuals or partners - Name / Title / Phone number of corporate officers

Contact Persons Name of persons to contact regarding purchase orders and invoice payment, title and phone number

Bank Reference:

Bank Details Account Number, Contact, Title and Phone Number:

Trade References: Company Name, Complete Address, Phone/Fax Number(s) & Account Number

I Agree I (We) agree to pay all bills for purchases net 30 days from the date of invoice and thereafter any invoice over 30 days a 1 ½% per month will be added to unpaid balance after invoice. The above information is herewith submitted for the purpose of opening an account and I do hereby certify this information to be true.