CREDIT APPLICATION

Fields marked with * are required

Company Name*

Years In Business

Owners Name*

UBI Number*

D&B Number*

Billing Name*

Billing Address*

City*

State/Province*

Zip/Postal Code*

Contact Email*

Contact Phone*

Shipping Name*

Shipping Address*

City*

State/Province*

Zip/Postal Code*

Contact Email (Shipping)*

Contact Phone (Shipping)*

Authorizing Party*

Title*

Date*

Chinese (Simplified)