Credit Application

```html

Primary Contact for Credit Inquiries

Name:

Title:

Email:

Phone:

Secondary Contact (Optional)

Name:

Title:

Email:

Phone:

Bank Reference

Bank Name:

Address:

City, Province, Postal Code:

Account Type (Checking, Savings, etc.):

Account Number (Last 4 digits for verification purposes):

Trade References

Company Name 1

Company Name:

Address:

City, Province, Postal Code:

Account Number (if applicable):

Contact Person:

Phone:

I have read and agree to the

{% form 'contact' %} {% if form.posted_successfully? %}

Thank you for submitting your application!

{% endif %} {% if form.errors %}

Please fix the following errors:

{{ field }}: {{ form.errors[field][0] }}

{% endif %} {% endform %}

Item added to your cart

Credit Application

Company Information

Business Structure

Primary Contact for Credit Inquiries

Secondary Contact (Optional)

Bank Reference

Trade References

Company Name 1

Country/region

Credit Application

Company Information

Business Structure

Primary Contact for Credit Inquiries

Secondary Contact (Optional)

Bank Reference

Trade References

Company Name 1