Infinityseal.com: Resources: Credit Application Online

The below information is for the purpose of obtaining credit and is warranted to be true. All information will be held in strict confidence, and will never be sold or given out. Please include all all requested information to make our job easier and your response time shorter.

Fill out PDF form online and submit via e-mail: CHOOSE
Print and Fax PDF form: CHOOSE

General Information

Today's Date:
Company Name:
Your Name:
Your Title:
Mailing Address:
Line 2:
City:
State, Zip:	,
Billing Address:	same
Line 2:
City:
State, Zip:	,
Phone:	x
Fax:
Email/Web Address:

Business Information

Years In Business:	We are a new company
EIN Number:
Type of Business:	Corporation Partnership Individual Other
Incorporated In:	as
Tax Exempt?:	No Yes: Tax Exempt #:
Dun & Bradstreet #:	No Yes: D & B #:
Requested Credit:	$
PO Required?:	No Yes	Billing Pref.:

Accounting Information

A/P Contact:
Phone:	x
Fax:

Trade References
[Give only names of those you currently buy from on open account]

Trade Reference #1
Company Name:
Contact:
Phone:	x
Fax:
State:	Years as vendor:
Trade Reference #2
Company Name:
Contact:
Phone:	x
Fax:
State:	Years as vendor:
Trade Reference #3
Company Name:
Contact:
Phone:	x
Fax:
State:	Years as vendor:

Bank Reference
[required for credit limit over $1000.00]

Bank Name:
Contact:
Account Number:
Address:
Line 2:
City:
State, Zip:	,
Phone:	x
Fax:

Any Additional Info:


Agreement
[for forms submitted via email, a blank credit application will be attached to email copy and faxed to applicant for signature to keep on record]

I agree to pay my account in accordance with Seal-Jet, LLC, Inc.�s regular terms. Seal-Jet, LLC, Inc.�s terms are Net 30 Days from invoice date. In the event any balance is not paid after this date, a 1-1/2% per month late charge will be assessed. I understand and agree that the purpose of the late charge is to induce prompt payment of the obligation. Further, if this account is placed in the hands of an attorney or collection agency for collection, I agree to pay all reasonable fees and costs incurred in any collection action, as determined by the court of jurisdiction. A $25.00 service charge will be assessed against applicants account upon receipt of any returned check by your bank. I have read and fully understand this agreement. My signature (digital or handwritten) below indicates my agreement with all of the above, and certifies that all the information in this document is factual and accurate.
Signed by: Title: Date: Signed by: Title: Date:

	Please only hit submit once.