Credit Application Step 1 of 8 12% Requirements for Credit Application* Open Account (Projected purchases min. $2,400/year) Are you a current CK Supply Customer?* Yes No If Yes, Please Provide Account Number (If Known) Your CK Supply Account Manager (If Known) Date MM slash DD slash YYYY Name of Firm FEIN or SSN # Billing Address Street Address City State / Province / Region ZIP / Postal Code Physical Address Street Address City State / Province / Region ZIP / Postal Code Headquarters Address Street Address City State / Province / Region ZIP / Postal Code Main PhoneFaxEmail Main ContactsKey Employee First Last TitlePresidentCEOCFOOwnerPartnerOtherKey Employee First Last TitlePresidentCEOCFOOwnerPartnerOther Are YouPlease select one. A Corporation A Partnership A Proprietorship Other State Incorporated In Type of BusinessPlease select the segment that best fits your business. Manufacturing Universities/Research/Laboratory/Medical Construction/Contractor Food & Beverage Government & Municipalities Metal Fabrication Mechanical Contractor Dry Ice Scrap Metal Cannabis Years in Business Tax Exemption Number Please Upload Your Tax ExemptionMax. file size: 10 MB. Are Purchase Orders Required? Yes No Will you accept invoices by email? Yes No If Yes, please provide email below!Email Do you want access to an online customer portal for your account?Online Ordering, View Invoices, Order History, Account Balances, Credit Memos, Cylinder Balances, Open Orders, Pay Bill with a Credit Card, & More! Yes No Email for Portal Access Accounts Payable Contact Information First Last PhoneFaxEmail Our Credit Policy is Net 30 DaysI understand that the information furnished above is for the purpose of obtaining credit from your u001erm. I fully understand your credit policy and agree to your payment terms. I am authorized in my capacity, to bind my u001erm accordingly. I agree that all accounts or monies due shall be due and payable at your business. I understand and agree that all past due invoices shall automatically accrue interest at the rate of eighteen percent (18%) per annum and further agree to pay these charges. Should it become necessary to place this account with any attorney for collection, it is agreed that I/MY firm will be responsible for any and all costs of collection, including reasonable attorney’s fees.Name First Last Title (Officer/Owner) Signature Reset signature Signature locked. Reset to sign again
