Online Credit Application
Please read the Terms of Sale page before filling out this application.

Business Information
Name of Business
Street Address
Mailing Address
Fax
City State Zip
Phone
Fax
Federal ID #
D & B #
Years in Business

Accounts Payable Contact
Phone
Extension
Email

Owners or Officers
Name
Address
City State Zip
SSN

Name
Address
City State Zip
SSN

Bank References
Institution
Address
City State Zip
Phone
Contact

Institution
Address
City State Zip
Phone
Contact

Trade References
Institution
Address
City State Zip
Phone
Contact

Institution
Address
City State Zip
Phone
Contact

Institution
Address
City State Zip
Phone
Contact

Institution
Address
City State Zip
Phone
Contact
In making this application, it is understood that all invoices are due and payable on or before the due date. The terms are net 30 days from statement date. If not paid on or before the due date, the account is then considered delinquent and subject to an 2% per month (24% annually) charge until paid. Applicant(s) agree to pay Eastpointe Manufacturing Corporation's attorney fees and court costs in collecting due under this credit application.
By submitting your name, you agree to the terms stated above and specified on the Terms of Sale page.


Applicant Name
Title
Date
 
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