Credit Application

Please complete all fields on the form below. In order to avoid a delay with the processing of your application, please use your company’s full Legal Company Name and DBA name where applicable. Enter the name EXACTLY as it appears on your Articles of Incorporation, Articles of Organization, Assumed Name papers or similar legal documentation. Please review all information carefully before submitting.

Company Information

Legal Company Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Years in Business:
Business Type:
Federal Tax Id:

Remittance Information

Division/Subsidiary (if different from above):
Billing Department Name:
Billing Address 1:
Billing Address 2:
Billing City:
Billing State:
Billing Zip Code:
Billing Country:
Invoice Via:
Billing E-mail:    
Billing Phone:
Billing Fax:

Accounts Payable Information

Name:
AP Address 1:
AP Address 2:
AP City:
AP State:
AP Zip Code:
AP Country:
AP E-mail:    
AP Phone:
AP Fax:

By clicking submit, I certify that (a) all information in the application is true, accurate, and complete; (b) I am the owner, principal, officer or authorized agent of the applicant listed on this application; (c) this application is submitted to Zack Products Corporation for business or commercial purposes; (d) the applicant expressly authorized Zack Products Corporation to obtain credit reports on the applicant business entity from any source, including credit bureaus and agencies; (e) I understand that federal law requires Zack Products Corporation to capture and record information to verify my identity, and may also require additional verifying information.

Submitters Name:
Submitters E-mail:    
Submitters Phone:



different image