BUSINESS CONTACT INFORMATION

Company Name

Company name

Country *

Type

Sole proprietorship
Partnership
Corporation
Other

Email *

Email

Mobile

Date

Registered company address

Address Line 1

City

State / Province / Region

Postal Code

Country

BUSINESS AND CREDIT INFORMATION

Bank name

Account number

DUNS number

Type of account

Savings
Checking
Other

Requested Credit Limit

Requested Payment Term

Net 7
Net 15
Net 30
Other

*Requested Credit Limit and Request Payment Term are only for the informational purpose. They might not be approved as requested.

Primary Company Address

Address Line 1

City

State / Province / Region

Postal Code

BUSINESS/TRADE REFERENCES

Vendor Reference #1

Company

Phone number

Email *

Email address

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Vendor Reference #2

Company

Phone number

Email *

Email address

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Vendor Reference #3

Company

Phone number

Email *

Email address

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

AGREEMENT

*By submitting this application, you authorize VECTORNATE USA Inc. to make inquiries into the banking and business/trade references that you have supplied.

SIGNATURE

Applicant Name

Date

Signature