Celling Biosciences Credit Application

    Type of Business:

    Number of years in business:

    Type of Company:

    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:

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