COMMERCIAL CREDIT APPLICATION

Thank you for your interest in a credit account with Labgear. We offer Net 30 day terms on approved credit, following an initial order. The application review process typically takes 2-3 business days.

1. Applicant Information

Legal Business Name *

Doing Business As (DBA)

Website

Physical Address *

City *

State *

Zip Code *

Billing Address (if different)

Phone *

Fax

Email *

Type of Business *

Date Business Established *

Federal Tax ID *

Number of Employees

2. Trade References (3 required)

Reference 1

Company Name *

Contact Person

Phone *

Fax

Reference 2

Company Name *

Contact Person

Phone *

Fax

Reference 3

Company Name *

Contact Person

Phone *

Fax

3. Bank Reference

Bank Name *

Bank Address *

Contact Person

Phone *

Account Number *

4. Purchase Authorization

Please list person(s) authorized to make purchases on this account:

Authorized Name *

Title *

Phone

5. Agreement

By submitting this application, I certify that all information provided is true and correct, and I authorize Labgear to conduct a credit check using the provided references. I acknowledge that I have reviewed and accepted the Labgearusa.com webpage's Terms and Policies.

I agree to the terms listed above. *

Signature (Printed Name) *

Title *

Date *