Enviro Safety Credit Limit Increase Request

Your Credit Limit Increase request has been received!

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Complete this form to request a Credit Limit Increase for your NET 30 TERMS with us.

See Terms & Conditions at the bottom of this form for more information.

Company Name *

Customer ID# *

Purchasing Contact Name *

Purchasing Contact Phone *

Purchasing Contact Email *

AP Contact Name *

AP Phone *

AP Email Address *

General AP Email Address *

Corporate Information

New Credit Limit Requested *

Your Enviro Safety Account Manager *

Terms and Conditions: All accounts are considered PrePaid via Credit Card until a credit application has been completed, reviewed, and approved. Once approved for NET 30 TERMS, you agree to remit payment within 30 days of your item(s) being shipped. If any indebtedness incurred pursuant to this request for credit is not paid in full when due, the undersigned agrees to pay all costs of collection, including reasonable attorneys fees. Any balance so remaining unpaid shall bear interest at the lesser rate of 1.5% per month or the maximum rate permitted by applicable law, until paid in full.

By typing your full name below, you are signing this agreement and indicating your authority to accept the terms and conditions as stated. In addition, you authorize Enviro Safety Products to make any and all inquiries necessary to process the Credit Application.

Authorized Company Representative, Signer *

Authorized Rep Title *

Authorized Rep Email *

Authorized Rep Phone *

Acceptance of Terms *

I Agree I do not agree, and do not wish to receive credit terms

Authorized Rep E-Signature *

Date Submitted *

Corporate Information

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