Application for Credit – Inversand Company

For further information, please contact:

Inversand Sales
P.O. Box 650 • 226 Atlantic Avenue
Clayton, New Jersey 08312
Tel: 856-881-2345
Fax: 856-881-6859
email: info@inversand.com
www.inversand.com

Alisa Blaylock - Sales Inquiries - ext. 271
Walt Seitz - All Shipping Inquiries - ext. 252

If you can not reach either person, please dial “0” for the operator

Fields designated with an asterisk (*) are required.

Your Information

Today's Date

22/12/2024

*Date Established

*Company Name

*Address

*City

*State

*Zip Code

*Phone

Fax

*Names of Principals

*Credit Line Desired

*Are you tax exempt?

Yes

Your Bank Information

*Bank Reference

*Address

*City

*State

*Zip Code

*Phone

Fax

*Account Number

*Contact

Trade References

*Company Name

*Address

*City

*State

*Zip Code

*Phone

Fax

*Account Number

*Company Name

*Address

*City

*State

*Zip Code

*Phone

Fax

*Account Number

*Company Name

*Address

*City

*State

*Zip Code

*Phone

Fax

*Account Number

Accounts Payable Contact Information

*Company Name

*Billing Address

*City

*State

*Zip Code

*Phone

Fax

*Accounts Payable Contact

*Phone

Fax

*Email

*Payment Method

Check

Wire Transfer

ACH/EFT