Credit Application for Commercial or Business Account

By submitting this form and applying for a business credit account, I agree to the following terms:

Any claims arising from invoices must be made within seven working days.
I hereby authorize Netarus, LLC to make inquiries into the banking and business/trade references I have supplied.
Terms are granted on a case-by-case basis following credit approval.

Please be sure to provide a D&B / DUNS number for fastest processing.

Please fill in this form with as much detail as possible. All information will be kept confidential.

* indicates required field

::Submitted by::

Name:*

Email:*

Your Position or Title:*

Phone:*

:::Company Information:::

Company Name:*

Website:*

Trading Name (if different):

Year business founded?*

Dun and Bradstreet (DUNS) Number:

Number of locations?

Number of employees:

Address (1):*

Address (2):

City:*

State/Province:

Postal Code:*

Country:*

:::Accounts Payable Information:::

Account's Payable (AP) Point of Contact Name:

AP Direct Phone Number:

(Include extension if applicable)

AP Email:

AP Fax:

Desired credit limit? ($USD)*

(Credit limit will be granted based on initial order size)

Anticipated first order size? ($USD)*

Reference Information

Banking Information including Name, Address and Point of Contact

Three (3) Customer and Vendor Trade References (if you prefer, please attach them as a separate document below)

Optional Attachment - Trade References (PDF or DOC format only please)

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.

Additional Comments: