Catalog    September 19, 2018

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USD Products - Credit Application
Bill To:
Company Name
Street Address
City
State
Zip
Federal ID#
Years in Business
# of Employees
A/P Contact
Phone
Fax
Ship To:
Please select:
Company Name
Street Address
City
State
Zip
Phone
Fax
Bank Reference
Bank Name
Bank Account #
Phone
Street Address
0 /
City
0 /
State
Zip
Trade References
1. Company Name
0 /
Phone
0 /
Fax
0 /
2. Company Name
0 /
Phone
0 /
Fax
0 /
3. Company Name
0 /
Phone
0 /
Fax
0 /
Authorized By:
Your Name
Title
Please acknowledge
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ECOA: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with the law concerning this credit is the Federal Trade Commission Division of Credit Practices, 6th and Pennsylvania Avenue, NW, Washington, D.C. 20580.