Credit Form - Unified Alloys

General Information

Legal Business Name:

Billing Address:

Address

City: State / Province: ZIP / Postal Code:

Ship-to Address

Address

City State / Province / Region ZIP / Postal Code

Phone:

Fax:

Website Address:

Business is a:

Corporation
Partnership
Sole Proprietorship

Number of years in business:

Latest Annual Sales:

Estimated Monthly Purchases:

Amount of Credit Required:

Nature of Business:

Executive Officer:

Finance Controller:

Invoicing Preference is by:

Email
Mail

Email Address:

Fax:

Trade References
(do not include office supply, courier or custom broker companies)

Company Name:

Address:

City State / Province / Region ZIP / Postal Code

Contact:

Phone:

Email:

Fax:

Company Name:

Address:

City State / Province / Region ZIP / Postal Code

Contact:

Phone:

Email:

Fax:

Company Name:

Address:

City State / Province / Region ZIP / Postal Code

Contact:

Phone:

Email:

Fax:

Bank References

Bank Name:

Contact:

Address:

Address

City State / Province / Region ZIP / Postal Code

Phone:

Email:

Primary Bank Account Transit Number:

Account Number:

DUNS number:

Accept the terms and conditions*

I understand and accept the terms and conditions

Referred by:

UA locations:

First Choice
Second Choice
Third Choice

Comments

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