Celling Biosciences Credit Application

Type of Business:

Number of years in business:

Type of Company:

CorporationPartnershipSole Proprietorship

Owners or Principals

Name:

Title:

Name:

Title:

Account Contacts

Accounts Payable Contact

Name:

Phone:

Fax

Email

Purchasing Contact

Name:

Phone:

Fax:

Email:

Tax and IDs

Federal Tax ID:

Do you have a resale or tax-exempt certificate?
YesNo
If you answered yes, we will require a copy before processing purchases without sales tax. This can be emailed with you final application.

Dun and Bradstreet Number:

Credit References

Compnay Name:

Contact:

Phone:

Fax:

Email

Address 1:

Address 2:

City:

State:

Postal Code:

Company Name:

Contact:

Phone:

Fax:

Email:

Address 1:

Address 2:

City:

State:

Postal Code:

Bank Information

Bank:

Contact:

Phone:

Fax:

Email:

Account Number:

Account Type: