National Conduit Supply Credit Application

Company

Email Address

Billing Address

Phone

Credit Limit Request

Business Type Business Type Sole Proprietor Partnership Corporation

State

Years in Business

D&B Number

Name/Addresses of Individuals/Partners —or— Name/Title/Phone Number of Corporate Officers (One per line please)

Name of Person to Contact Regarding Purchase Orders and Invoices. PLEASE INCLUDE Title, Address, and Phone.

Bank References (List Bank Name, Contact, Title, and Phone Number)

Trade References (List Company Name, Address, Contact, Title, and Phone Number)

First Name

Last Name

Your Title

By checking this box, applicant attests financial responsibility, ability, and willingness to pay our terms of sale. In consideration of National Conduit Supply extending credit, applicant further agrees that NCS, at its option, may charge interest on all past due accounts. Applicant agrees to pay reasonable attorney’s fees and costs of collection in the event that this account is referred to any attorney for collection. The applicant understands that the requested information is given for the purpose of obtaining credit and authorizes the investigation of this information. I certify that I am one of the referenced principals, officers, or otherwise duty authorized personnel of the company and that the given statements are true and complete.