Credit Application

Need to use a purchase order? No problem. Here’s what you need to do:

Complete the form below
Or:

Download our Business Credit Application. Get the application as a PDF.
Email the completed form to us at sales@sumakenorthamerica.com.

We will review the application and give credit approval within 5 business days. Once your credit is approved, simply call us at 1-603-402-9952 or email us at sales@sumakenorthamerica.com to place your order using a purchase order number.

Phone

This field is for validation purposes and should be left unchanged.

Instructions for Completion:
Please fill out all sections of the application form.
Press Submit to return the completed form to sales@sumakenorthamerica.com.

1. Business Information

Business Legal Name:

Business Trade Name (DBA):

Type of Business Entity:

Federal Tax ID (EIN):

Business Address:

City:

State:

ZIP:

Phone Number:

Website URL (if applicable):

Contact Name:

Email Address:

2. Business Details

Year Established:

Business Structure:

Nature of Business:

Number of Employees:

Accounts Payable Contact Name:

Accounts Payable Email:

Accounts Payable phone #:

Email to submit invoices to:

Business Bank Name:

Bank Phone Number:

Business Credit References (List 3 trade references):

Company Name:

Contact Name:

Phone Number:

Email Address:

Account Number:

Credit Terms:

Company Name:

Contact Name:

Phone Number:

Email Address:

Account Number:

Credit Terms:

Company Name:

Contact Name:

Phone Number:

Email Address:

Account Number:

Credit Terms:

3. Business Financial Information

Annual Gross Sales:

Net Profit (last fiscal year):

Is the business currently involved in any litigation?

Yes

Has the business ever filed for bankruptcy?

Yes

4. Authorization

By signing below, the undersigned authorizes the creditor to conduct a credit check and/or verify the information provided herein. The undersigned also understands that any false or misleading information may result in denial of credit.

Use a finger or mouse to sign.

Signature:

Name:

Title:

Date: