Credit Application

Want to download and print the form instead? Once you have the form filled out, please send the application to sales@ziptie.com for credit approval.

Company Contact Information
Name*
First Last
Name of Business*
Tax ID Number*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Customer Email*
Fax*
Credit Limit Requested*
Company Details
Type of Business*
Duns*
Legal Form Under Which Business Operates*
- Corporation
- Partnership
- Proprietorship
State*
If Division/Subsidiary, Name of Parent Company*
In Business Since*
Name of Company Principal Responsible for Business Transactions*
Title*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Bank References - Checking Account
Institution Name*
Checking Account*
Address*
Phone*
Bank References - Savings Account
Institution Name*
Savings Account*
Address*
Phone*
Trade Reference #1
Company Name*
Account Number*
Email*
Fax
Address*
Phone*
Trade Reference #2
Company Name*
Account Number*
Email*
Fax
Address*
Phone*
Trade Reference #3
Company Name*
Account Number*
Email*
Fax
Address*
Phone*
Comments
This field is for validation purposes and should be left unchanged.

Company Contact Information