Credit Application

Industrial PC offers NET 30 terms to qualified applicants. Please fill out the form below or send a copy of your information to sales@industrialpc.com.

1Company Information

2Bank Reference

3Trade References

Company Information

Company Name(Required)

Division/Department

Purchasing Contact Name(Required)

Purchasing Email(Required)

Purchasing Phone(Required)

Accounts Payable Contact Name(Required)

Accounts Payable Email(Required)

Accounts Payable Phone(Required)

Is This (AP Email) Where Invoices Get Sent?(Required)

Yes

No

Email to Send Invoices(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Business

Number of Years in Business

SIC Code

D&B Number

Do You Have a UPS Account to Ship on?(Required)

Yes

No (Shipping cost will be added to the invoice)

Your UPS Account Number(Required)

Bank Reference

Bank Name(Required)

Account Number(Required)

Bank Contact Person Name(Required)

Bank Contact's Email(Required)

Bank Contact's Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title

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