CREDIT APPLICATION Apply For Credit With EDM 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 * Send