Credit Application Apply for credit terms with Campbell Scientific

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Print Version
(for faxing or emailing)

Please provide the following information:

All information will be held in the strictest confidence (*=required field).

Company Legal Name*

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Email*

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Address*

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Dun & Bradstreet #

City*

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State*

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Zip/Postal Code*

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Federal ID #

Company Type

Corporation
Sole Proprietorship
Partnership

Nature of Business*

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Contact Person*

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Years in Business*

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Phone Number*

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Fax Number*

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Credit Amount Requested*

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A/P CONTACT PERSON

Name*

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Email*

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Phone*

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OWNERSHIP

Name* (president)

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Email*

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Phone*

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FINANCES

Bank Name*

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Contact Person

Bank Address*

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City*

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State*

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Zip*

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Account Numbers*

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Bank Contact Email

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Fax*

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REFERENCES

Company*

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Contact Person

Email*

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Phone

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Company*

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Contact Person

Email*

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Phone

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Company*

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Contact Person

Email*

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Phone

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Relevant Attachments (PDF or DOC)

I hereby authorize Campbell Scientific, Inc. (CSI), to verify any credit information provided by this source document. I further authorize our banks, trade references and financial institutions the right to release by telephone or fax all credit information requested by CSI. We understand that ANY information obtained by CSI will be held in confidence. The requested information will be used solely in assisting and securing credit terms for the applicant.

Credit privileges are hereby requested and it is understood and agreed that upon approval, the terms of payment are net within 30 days from the date of shipment. Delinquent accounts are subject to a finance fee of 1^1/2% (18% annually) late charge until order is paid in full. Buyer will also be charged reasonable attorney's fees should collection by suit be required.

WE CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT, AND THAT WE CAN AND WILL COMPLY WITH CSI'S TERMS. Please acknowledge that you accept the terms of this application

Name*

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Title*

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Date*

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Authorized Signature*

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Sign by typing your name between two slashes: /John Doe/

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