Credit Application

Business Information

Business entity name *

Group Name (If part of group or DBA)

Bill To Address *

City *

State / Province *

Zip / Postal Code *

Ship To Address

City

State / Province

Zip / Postal Code

Name of owner

Email *

Phone *

Fax

In business since

Website

Tax Exemption #

Required Email addresses for Order & Invoice Communication

Order Confirmation

Tracking Information

Invoices

Accounts Payable and Credit Information

Accounts payable contact name

Phone #

Ext.

Alternate accounts payable contact name

Phone #

Ext.

Business/Trade References

Company name

Contact name

Phone

Address

City

Zip / Postal Code

Company name

Contact name

Phone

Address

City

Zip / Postal Code

Bank Info

Name

Phone

Acct #

Address

City

State / Province

Zip / Postal Code

Signature

Print name

Title

By submitting this application, you authorise Circle Specialty to make inquiries into the business/trade references that you have supplied.