Credit ApplicationAdam Whitaker2022-10-22T20:34:35-05:00

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.

[Active] Credit Application

Company Information

Company Name *

Division/Department *

Purchasing Contact *

Purchasing Email *

Accounts Payable Contact *

Accounts Payable Email *

Engineering Contact

Engineering Email

Address

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Type of Business

Number of Years in Business

SIC Code

D&B Number

Bank Reference

Bank Name *

Account Number *

Contact Person *

Phone *

Address

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Trade References

Reference #1

Company Name *

Contact Person *

Phone

Email Address

Reference #2

Company Name *

Contact Person *

Phone

Email Address

Reference #3

Company Name *

Contact Person *

Phone

Email Address

reCAPTCHA

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