Globalfluid.com Credit Application

In making this application, I/we understand that all accounts, unless otherwise arranged are payable according to the terms set by globalfluid.com. If not paid on or before terms stated the account will be considered delinquent. I/we agree to personally guarantee payment of all invoices and legal service charges added each month on past due invoices.

Please provide the following information.  ALL applicable information is necessary for us to process your application and your first order as quickly as possible.

Corporate Name
Trade Name
E-mail
URL
BILLING
Street Address
City State Zip Code
Phone

FAX

Contact

Title

Shipping    (If different from above)
Street Address
City State Zip Code

Choose one of the following options:    Year established 

If a Corporation, please list officers:

Name

Title

Name

Title

Name

Title

If not a Corporation:

Social Security #
Drivers License #

Trade References:

Name

Address

Phone

Fax

Name

Address

Phone

Fax

Name

Address

Phone

Fax

Bank Information:

Bank

Account #

Branch

Phone

Officer

 

Submitted by: Title


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