Union Supply Co. Credit Application

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Please fill out the following credit application form

Email *

Company Name: *

Billing Address: *

Add complete billing address.

Shipping Address: *

Type "Same as above" if the shipping address is the same as the billing address. If not please provide complete shipping address.

Years in business *

Purchasing Contact Name: *

Purchasing Contact Phone Number: *

Purchasing Contact Email Address:

A/P Contact Name: *

Please advise who we contact for bill payment.

A/P Contact Phone Number: *

A/P Contact Email Address: *

Please advise email address of your accounts payable contact.

Credit Reference #1: *

Please provide business name, phone number and email address of credit reference #1.

Credit Reference #2: *

Please provide business name, phone number and email address of credit reference #2.

Bank Information: *

Please provide bank name, address, bank contact name, phone and email address.

Authorized Person: *

Please advise who is able to purchase products/services on your account along with phone and email address.

Credit Limit Amount Requested: *

Please let us know what kind of credit limit amount you require.

Payment Type: *

Please let us know what method you prefer to pay your account outstanding balances.

A copy of your responses will be emailed to the address you provided.

Submit

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