EmailMe Form - E&E Custom Products Application for Credit

Company Name *
Phone *
### - ### - ####
*

Street Address City State / Province / Region Postal / Zip Code Country / Region
Do you require a monthly statement
Yes
No
Owner Namer
Type of Business
Years at present location
Years Established
Is Business Incorporated?
Yes
No
License Number
Bank Name *
Bank Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Account Number *
Please fill out all 3 references below:

Name/Company *
Email
Fax
### - ### - ####
Name/Company
Email
Fax
### - ### - ####
Name/Company
Email
Fax
### - ### - ####
Billing Information
Tax Number
Extra Invoices
TERMS
NET 30 DAYS
FOB Shipping Point

Should E&E Custom Products LLC find it necessary to place an account for collection, the customer agrees to pay all costs, and attorney fees.

Accounts which are perpetually slow pay, will jeopardize their shipments.

We understand your terms and agree to meet these terms if credit is extended.
Do you agree with the terms and conditions? *
Yes, I agree.
Name *
Initial *
Date *
MM / DD / YYYY
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