Credit Application Form | National Polymers Inc.

All information must be completed in detail or application will not be processed.

COMPANY NAME

Address

City

State / Province

Postal / Zip code

Phone Number

Mobile Phone Number

Fax Number

Email address

COMPANY DETAILS

Federal ID#/SSN

Dunn and Brad Street Rating

Number of Employees

Company Type

DATE INCORPORATED

STATE INCORPORATED

Annual Sales

Net Worth

Credit Amount Desired

Owner/President Name

Address

City

State

ZIP Code

Home Phone

Mobile Phone

TRADE REFERENCES

Company Name Reference 1

Street Address

City

State

ZIP Code

Phone Number

Fax Number

Company Name Reference 2

Street Address

City

State

ZIP Code

Phone Number

Fax Number

Company Name Reference 3

Street Address

City

State

ZIP Code

Phone Number

Fax Number

Bank Name

Street Address

City

State

ZIP Code

Phone Number

Fax Number

UPLOAD ADDITIONAL DOCUMENTS/CREDIT INFORMATION (optional)

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VIEW OUR TERMS AND CONDITIONS OF SALE

By clicking the box below, I agree that the information submitted is corect to the best of my knowledge. I am aware that any and all invoices rendered are expected to be paid within the stated terms and failure to comply could result in the cancellation of extended credit privileges. I have read the terms and conditions of sale and the disclaimer of warranties and limitations of our liability.

This information is correct to the best of my knowledge. I agree to NPI's terms and conditions of sale.

YOUR NAME

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