Credit Application - North America & Canada
Name of Person Completing the Form: *
Your answer
Job Title: *
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Your Email Address: *
Your answer
Date: *
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DD
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YYYY
Location: *
How are you buying from us?: *
Optimas Contact: *
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Complete Legal Name of Company: *
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Trading Name or DBA: *
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Billing Address: *
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Delivery Address(If different above):
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Headquarters Address: *
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TAX Registration No: *
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Tax Exempt (If Yes please Send Tax Exempt Form to creditapplications@optimas.com): *
If Canada, Registry No. of Company:
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Website Address:
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If Applicable, Parent Company:
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