Customer Credit Application

Customer Credit Application

Please complete this form to apply for a credit account. All information is required unless otherwise specified. Refer to the instructions provided.
Business Information
Legal Business Name
Shipping Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Billing Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email
example@example.com
Type of Business
Date Business Established

MonthDayYear
Date
Federal Tax ID (EIN)
Accounts Payable Contact Name

First NameLast Name
Accounts Payable Phone
Please enter a valid phone number.Format: (000) 000-0000.
Accounts Payable Email
example@example.com
Terms and Conditions
It is understood that in consideration of Sure Controls Inc. selling merchandise and services to the undersigned, the undersigned agrees to the following credit terms and conditions:

1. Payment for all purchases is due within 30 days following the date of invoice.

2. Sure Controls Inc. reserves the right to place any account on prepayment terms only at any time due to payment issues.
Authorized Signature
Printed Name of Authorized Signer

First NameLast Name
Title/Position
Date Signed

MonthDayYear
Date
Please upload a completed W-9 form.
Upload W-9

Upload a completed W-9 form.
Cancelof
Re-sale Certificate

Cancelof
Should be Empty: