[[[["field14","equal_to","No"]],[["show_fields","field16"]],"and"]] 1 Step 1 Your Namefirst and last Company NameNeeds to be exact company name, not your DBA Emailemail Phone Federal Tax ID Legal business typeCorporationLLCPartnershipS-CorpSole ProprietorshipOther Billing addressStreet, city, state Is your billing and shipping address the sameYesNo Shipping addressStreet, city, state Type of business Expected Volume of Ordersplease provide an estimated dollar amount Existing Brass Fitting Suppliersplease provide the names of all existing suppliers Name of your company's bank Bank's address Reference #1 Business name and contact nameplease provide both pieces of information if available Contact informationplease provide phone, email and address if available Reference #2 Business name and contact nameplease provide both pieces of information if available Contact informationplease provide phone, email and address if available Reference #3 Business name and contact nameplease provide both pieces of information if available Contact informationplease provide phone, email and address if available I agree to the terms belowYes Applicant's signature attests financial responsibility, ability, and willingness to: Pay our invoices in accordance with terms stated on invoices. There will be a 1.5% per month service charge on invoices past due. The above information is for the purpose of obtaining credit and is warranted to be true. We hereby authorize Couplings Company, Inc. to investigate the references listed pertaining to our credit and financial responsibility. This application will be regarded as confidential material. reCaptcha v3 Submit Application keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder
