New Customer Credit Application

New Customer Application

Contec Americas
Legal Business Name
Trade Name - DBA
Year Founded
Main Phone Number

Area CodePhone Number
Website
Company Shipping Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Company Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Accounts Payable Contact

First NameLast Name
Accounts Payable Email
example@example.com
Accounts Payable Phone

Area CodePhone Number
Accounts Payable Fax

Area CodePhone Number
Tax Exempt Certificate Number
Upload Tax Exempt Certificate

Browse Files
If you do not with to upload your tax exempt certificate at this time, you may email it to ar.billing@us.contec.com within the next 5 business days. Cancelof
Federal ID Number
Payment Terms Requested
Please note, there is a processing fee of 2% for credit card purchases.

Financial Statements
Please upload financial statements (income statement, balance sheet, statement of cash flow) for the current year-to-date and prior year. All information will be used solely for the purpose of establishing credit. It will not be shared with a third-party unless required by law.

Browse Files

Cancelof
PLEASE NOTE: If you are unable to upload your financial statements at this time, you may email the files to ar.billing@us.contec.com within the next 5 business days.

Trade References

Please provide three trade references. Major suppliers only, no distributors.
- Company Name
- City and State
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Account Number
- E-mail
- Phone Number
  
  Area CodePhone Number
- Fax Number
  
  Area CodePhone Number
- Company Name
- City and State
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Account Number
- E-mail
  example@example.com
- Phone Number
  
  Area CodePhone Number
- Fax Number
  
  Area CodePhone Number
- Company Name
- City and State
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Account Number
- E-mail
  example@example.com
- Fax Number
  
  Area CodePhone Number
- Phone Number
  
  Area CodePhone Number

Bank Reference