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.

Download Credit Application

Full Name*

Email Address*

Name of Business*

Tax ID Number*

Address*

Address Line 2

City*

State

Zip Code

Phone*

Fax*

Credit Limit Requested*

Business Deatils

Type of Business*

Duns*

Legal 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*

Address Line 2

City

State

Zip Code

Phone*

Bank References - Checking Account

Institution Name*

Checking Account*

Address*

Phone*

Bank References - Savings Account

Institution Name*

Checking Account*

Address*

Phone*

Trade Reference #1

Company Name*

Account Number*

Email*

Fax

Trade Reference #2

Company Name*

Account Number*

Email*

Fax*

Trade Reference #3

Company Name*

Email*

Fax

Message*