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Credit Application for a Business Account

Please complete the following questions.  We will review the information and contact you once we have the account information ready.

Thank you for contacting us.

* denotes required field

Contact Name:*
Company Name:*
Billing Address:*
99999 characters remaining
Billing City:*
Billing State:*
BIlling Zip Code:*
Billing Phone:*
Billing Fax:*
E-mail: *
Shipping Address:*
99999 characters remaining
Shipping City:*
Shipping State:*
Shipping Zip Code:*
Shipping Phone:*
Check One (Organized As):*
Trade Reference - Company Name 1:*
Account Number 1:
Phone Number 1:*
Fax Number 1:*
Trade References:Company Name 2:*
Account Number 2 :
Phone Number 2:
Fax Number 2:*
Trade References:Company Name 3:*
Account Number 3:
Phone Number 3:*
Fax Number 3:*
1. Credit terms are net 30 days from the date of the invoice, C.O.D. without approved credit. *
2. If legal action is required for collection, we agree to pay reasonable fees resulting in such action.*
3. By submitting this application, you authorize Blasters Tool and Supply Co. Inc., to make inquiries into the banking and business/trade references that you have supplied.*
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