This credit application form is for on-line processing if you prefer you may use a printable form and FAX or MAIL it to us for prompt attention.

Click here for the FAX-MAIL Credit Application Form

CREDIT APPLICATION
on-line version

Legal Name of Organization

Name Officer Requesting Credit:

    Doing Business As:

                  TAX ID#

Type of Organization: Corporation Not-for-profit Sole Propietorship Individual Partnership Limited Liability Company

Years in business: State or Country where organized:  

Dun & Bradstreet#  

How much credit does your company wish to establish?

Is your company listed on a public exchange? If Yes please give trading symbol

Gross sales of company in last tax year:

Taxable Income of company in last tax year:

Note: Because it ties up excessive capital, Nutrin cannot Prepay and Add freight charges. Nutrin offers shipping via Freight Collect with your preferred carrier, or at your company's option, Nutrin can ship freight collect via its own freight broker who can normally arrange shipments at a very competitive rate. If your company wishes to use this form of shipment, Nutrin will submit this credit application to the freight brokerage for its own independent evaluation and if credit is given by the freight brokerage Nutrin can ship via freight collect using that freight brokerage company.

Small print:  Nutrin accepts no liability or responsibility for any decision by any freight brokerage company to extend or not extend credit, and accepts no liability whatsoever for any omission or failure on the part of freight brokerage company.

Name of preferred freight company

Your account number with preferred freight carrier

Do you wish Nutrin to submit this credit application to freight brokerage company? no

PRIMARY BANK INFORMATION (Bank where checking account is maintained):

Name of Bank:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active:

SECONDARY BANK INFORMATION (Bank where your company has loans outstanding):

Name of Bank:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active:

TRADE REFERENCE INFORMATION: 1

Name of Reference:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active:

Name of Reference:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active:

TRADE REFERENCE INFORMATION: 3

Name of Reference:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active:

Name of Reference:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active:

Name of Reference:

Street Address:

Street Address:

City:

State or Province:

ZIP or Postal Code:

Telephone Number:

Name of Contact Person Familiar with Account:

Account Number:

Years Account Active: