*INSTRUCTIONS* - All fields below with a red asterik are required fields, please make certain to review this application carefully and be as thorough as possible when completing it. - The Captcha on this form have been implemented in order to distinguish human from machine input, as a way of thwarting spam and automated extraction of data from our website and are intended for security purposes only! - If you currenlty have a Credit Reference Letter/Form that you would like to submit instead of completing sections 1-4 then please upload (PDF only) it here by clicking the Browse button below? If you choose this option then please know, there are still required fields that you MUST complete in each section in order to complete the credit application process.
1. Business Contact Information
2. Business and Credit Information
3. Banking Information
4. Trade References
5. Credit Card - A credit card is required to be on file with a Net Account, for ASC protection only! Prior to charging your card, you will be notified and provided an accounts receivables summary.
6. Other Required Information
If yes, please attach a copy of tax permit (PDF only)
* Please attach most recent copy of W-9 (PDF only)
7. Authorized Signature for Credit Application - By signing this agreement you guarantee that all the information provided on the Credit Application is true to the best of your knowledge. Also, by signing this agreement you authorize Accurate Safety Compliance to make inquiries into the banking and business/trade references that you have supplied.