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Credit Line Application

This credit line application is optional. If you would like to apply for a credit line with ChemPoint.com, please complete the form. You may choose to provide this information at a later date. Click here to continue without completing credit application.

Company: *

Primary Address: *

City: *

State/Province:

Zip/Postal:*

Country:

Telephone: *

Fax:

Doing Business As:

DUNS Number:

SIC Code

Billing Address (if different from above): -

Address:

City:

State/Province:

Zip/Postal:

Country:

Legal Structure

Corporation


President:
Vice President:
Treasurer:
Secretary:

Partnership


Partners:

Sole Proprietorship


Owners:

LLP


Business Start Date (year):
Fiscal Year End:
Annual Sales Volume:
Latest Fiscal Year End

Bank Reference

Bank Name: *

Address: *

Contact Person: *

Phone Number: *

Type of Account:

Borrowing

Non Borrowing

Account Number: *

Trade References

Company Name: *	*
Address: *	*
Contact Person: *	*
Phone Number: *	*

Company Name: *	*
Address: *	*
Contact Person: *	*
Phone Number: *	*

Company Name: *	*
Address: *	*
Contact Person: *	*
Phone Number: *	*

Contact ChemPoint




Asia Pacific
Toll Free:
Phone:		+65.6408.3800
Fax:
Email:		InfoAPAC@chempoint.com


Europe
Toll Free:		00.800.2436.7646
Phone:		+31.43.711.01.00
Fax:		+31.43.711.02.82
Email:		prospect@chempoint.com


North America
Toll Free:		800.485.9569
Phone:		425.378.8600
Fax:		425.378.8675
Email:		prospect@chempoint.com


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