COUNT ON US.

CUSTOMER CREDIT APPLICATION

Please fill out the online application below or download customer application (link is below) to fill out manually and email back to [email protected] or call (888) 268- 7686 Option #3.

Credit-ApplicationDownload
Today’s Date
Legal Business Name
Trade Name – DBA
Federal ID #
Billing Address
Check here if Mailing Address is the same as Billing

Mailing Address
Year Started
Federal ID / EIN#
Company Website
Dun & Bradstreet #
Are you a:
If you selected a Subsidiary or a Division of a Parent Company, please list the following:
A/P Contact
Accounting Phone
Accounting Email
Terms Requested:



If you checked ’30 Day Net Terms’, please type in Credit Limit ($) Request below.
Please Select One:
First & Last Name
Direct Phone Number
Email
Bank Company Reference
Bank Contact Name
Bank Address
Bank Phone
Type of Account


Trade Reference #1
Trade Reference Phone#
Address
Please enter any other pertinent information.

Signature

Signature (Typed)
Today’s Date