Global Specialty Products - environmentally safe, non-hazardous, non-flammable, biodegradable and recyclable aqueous and solvent based industrial cleaning products.

* Contact Name:

* Company Name:

* Street Address:

* Mailing Address:

* City:

* State:

* Zip Code:

* E-mail:

* Phone:

Fax:

No. of Employees:

* Federal tax ID/ Social Security #:

SIC Code#:

* D & B#:

RATING:

Type of Business:

Date Business Established:

* Amount of Credit Requested:

Purchase Order Required?:

Authorized Purchasers:

Bank References

Bank# 1

* Name:

* Account#:

Address:

* Phone:

Contact Person:

Bank# 2

Name:

Account#:

Address:

Phone:

Contact Person:

Trade References

Reference #1

* Name:

* Phone:

Reference #2

* Name:

* Phone:

By submitting this form, I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself. I have read the terms and conditions stated below and agree to all of these terms and conditions.

* Submitter's Name:

* Title:

GENERAL TERMS AND CONDITIONS AND
PERSONAL GUARANTEE

I understand payment terms are net 30 days. The submitter's name that appears above, authorizes bank and vendors to relaease credit history to your company. Past due accounts are subject to having shipments held. A service charge of 2% per month will be added to all amounts past due 30 days or longer.No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.

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Credit Application