CREDIT REQUEST FORM

Business Name*
Address*
Street Address Address Line 2 City State ZIP Code
Year Business Opened
Name*
First Last
Phone
Phone*
Fax
Email*
Federal ID #*
Resale #
REFERENCES
Please Furnish 3 Metal Finishing / Plating Referenced
Business Name
Phone
Business Name
Phone
Business Name
Phone
BANK REFERENCE
Bank Name*
Account #*
Address
Street Address Address Line 2 City State ZIP Code
Phone
Date Account Opened
MM slash DD slash YYYY
The undersigned hereby agrees that should a credit account be opened, and in the event of default in the payment of any amount due, and if such account is submitted to a collection authority, to pay an additional charge equal to the cost of collection including court costs. The credit terms at E.M.E., Inc. are net 30 days. Accounts may be placed on hold upon reaching 60 days. The undersigned hereby consents to E.M.E. performing credit verification.
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REFERENCES