Credit Application

Credit Request Amount*
Company Overview
Legal Business Name*
Trade Name - DBA
Website
Company Contact*
Phone Number*
Email*
Billing Address
Street Address*
Suite/Unit
City*
State*
Zip Code*
A/P Contact
Contact Name*
Email*
Phone Number*
Purchasing Agent
Contact Name*
Email*
Phone Number*
Company Details
Type of Business*
State of Registration*
Years in Business*
Federal ID #*
Estimated Annual Sales*
Nature of Business*
Are you a subsidiary?*
Years in Business*
Bank Reference
Bank Name*
Account Number*
Contact Name*
Phone Number*
Email*
Trade Reference - PLEASE PROVIDE UPDATED CONTACTS FOR REFERENCES
Business Name*
Contact Name*
Email*
Phone Number*
Business Name
Contact Name
Email
Phone Number
Business Name
Contact Name
Email
Phone Number
Terms & Conditions

• Applicant hereby applies for credit from SupplyNet, Inc. (Creditor), and agrees to be bound by all of the terms and conditions contained in this credit application. Applicant agrees to pay for purchases of goods and services according to the terms of Creditor currently in force at the time of each order,which are posted at https://www.thesupplynet.com/sales-terms-andconditions and which supersede any sales agreement, purchase order, or other document that may have different terms than those of Creditor, unless Creditor specifically agrees to different terms in writing.

• Creditor reserves the right to terminate credit and delivery accommodations at its sole discretion. Applicant agrees to be responsible for all collection costs and attorney's fees incurred in connection with the collection of any delinquent amount. This agreement shall be governed by and construed in accordance with the laws of the State of New York with venue only in the County of Rockland.

• Creditor is authorized to check bank and credit references, and to obtain any commercial and consumer credit reports that Creditor deems necessary to determine credit worthiness of applicant or their business.

• Persons signing this application certify that all information contained in this application and any attachment or amendment is true, correct, and complete to the best of their information, knowledge, and belief.
By checking this box, you agree and certify that by typing your name below it is your intent to sign, authenticate, and adopt this document and that the below electronic signature is valid and legally binding and shall have the same force and effect as a manual signature.
Print Name*
Title*
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Company Overview

Billing Address

A/P Contact

Purchasing Agent

Company Details

Bank Reference

Trade Reference - PLEASE PROVIDE UPDATED CONTACTS FOR REFERENCES