North American Credit Application

Company Information
Company Name*
Website URL*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Contact Information
Purchasing Agent Name*
Purchasing Agent Title*
Purchasing Agent Email*
Purchasing Agent Phone Number*
A/P Contact Name*
A/P Contact Title*
A/P Contact Email*
A/P Contact Phone*
Company Details
Type of Business*
- Proprietor
- Partnership
- Corporation
- LLC
Number of Employees*
Year Established*
Credit Limit Requested*
DUNS #
Bank Reference
Bank Name*
Bank Contact Name*
Bank Contact Email*
Bank Contact Phone Number*
Bank Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Numbers*
Trade Reference 1
Company Name*
Company Contact Name*
Company Contact Email*
Company Contact Phone Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Numbers*
Trade Reference 2
Company Name*
Company Contact Name*
Company Contact Email*
Company Contact Phone Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Numbers*
Terms & Conditions
Consent*
I agree to the privacy policy.
1. The information supplied in this application is warranted to be true and correct and is provided to Drytac for the purpose of obtaining credit.

2. We fully understand and agree to payment term of NET 30 upon approval of this credit application and further agree to accept and pay for any financial expenses incurred by Drytac to collect any of our past due amounts, including but not limited to, the original debt, any assigned reasonable collection costs, attorney fees, court costs, and any other related expenses.

3. All invoices and unpaid charges are due within 30 days of the invoice date. All accounts past 30 days are considered delinquent.

4. We may close your account if it becomes delinquent or if you have a significant change in management or ownership.

5. You agree to notify us of any significant changes in management or ownership.

6. We may change these terms and conditions at any time. We will notify you by mail if these terms and conditions change.

I have reviewed this application and read, understand, and agree to the Terms and Conditions above.
Signature*
Electronic Signature of Authorized Official (must be an Owner, Partner or Corporate Officer)
/S/ must be on the electronic document for a valid signature. Example: /S/ John Doe
Name*
First Last
Title*
Date*
MM slash DD slash YYYY

North American Credit Application

Company Information

Company Contact Information

Company Details

Bank Reference

Trade Reference 1

Trade Reference 2

Terms & Conditions

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