New Accounts | AJ Adhesives

At AJ Adhesives we have one goal …

To be the most responsive adhesive supplier in the business. Below is our credit application form. Please fill this out this form to prepare for your first order with us. Please also follow the instructions below to submit your W9 and tax exempt information to NewAccountSetup@ajadhesives.com.

We appreciate your business.

Confidential Credit Application

"*" indicates required fields

Company Name*

Name as listed on W9

DBA*

Doing Business As

Billing Address*

Street Address City State Zip Code

Ship To Address*

Street Address City State Zip Code

Phone*

Hidden

Fax

Referring Salesman*

Company Is*

Corporation

Partnership

Sole Proprietorship

LLC

LLP

Federal Tax ID:*

StateTax Exempt #:*

Accounts Payable Information

A/P Contact’s Name*

A/P Phone Number*

Direct If Available

Email Address for invoices*

Email Address for statements*

Purchasing Information

Purchasing Contact:*

Purchasing Phone Number:*

Direct if available.

Purchasing Email Address:*

Bank Information

Bank Name:*

Bank Phone Number:*

Bank Address:*

Street Address City State Zip Code

Credit Terms are 30 days from date of invoice. With my signature below or submission of my own credit form I am authorizing the release of any credit information for the completion of this credit application and I certify the information provided above or attached is correct. The undersigned agrees to pay all collection costs, court costs, and legal fees incurred to collect delinquent balances.

Signature:*

Name:*

Title:*

Date*

What to do next:

After submitting this form, submit company W-9, tax exempt letter/certificate or resell permit to NewAccountSetup@ajadhesives.com