Billing Company Name
Billing Address 1
Billing Address 2
Billing City
Billing State
Billing Postal Code
Billing Country
Billing Phone
Billing Email
AP Contact First Name
AP Contact Last Name
AP Contact Email
AP Contact Phone
Ship to Company Name
Ship to First Name
Ship to Last Name
Shipping Address 1
Shipping Address 2
Shipping City
Shipping State
Shipping Postal Code
Shipping Country
Shipping Contact Phone
Shipping Contact Email
Please provide your multiple ship to locations. Include: Ship to Name, Address, City, State, Postal Code, County, Phone and Email for each location.
Multiple Ship To Locations
IMPORTANT: If your business is tax exempt or resale, exemption or resale certificate(s) that cover each ship-to location must be provided. If you have multiple locations, it may be easiest to send a multijurisdictional certificate listing all locations. Please note that we are required to charge the appropriate state's sales tax unless a copy of these certificates has been received prior to invoicing.
Tax Exempt or resale exemption or resale certificate
Customers outside of the United States, need to provide broker Information
Broker Company Name
Broker Contact Name
Broker Address
Broker City, State, Postal Code, Country
Broker Phone Number
Broker Email
Company's Account Number
Exodus Global and our companies invite you to complete our credit application, which will provide you net 30 payment terms. If credit is not complete, payment will be due prior to shipment of order
Owners/Officers
Trade References (Firms currently extending credit)
Trade Reference 1 - Name
Trade Reference 1 - Address
Trade Reference 1 - Phone
Trade Reference 1 - Email
Trade Reference 1 - City, State, Postal Code
Trade Reference 2 - Name
Trade Reference 2 - Address
Trade Reference 2 - Phone
Trade Reference 2 - Email
Trade Reference 2 - City, State, Postal Code
Trade Reference 3 - Name
Trade Reference 3 - Address
Trade Reference 3 - Phone
Trade Reference 3 - Email
Trade Reference 3 - City, State, Postal Code
Bank Reference
Bank Name
Bank Contact Name
Bank Address
Bank Phone
Bank City, State, Zip Code
We hereby apply for credit and confirm financial responsibility, ability and willingness to pay all invoices in agreement with these terms. The above information is warranted to be true and complete. We hereby authorize Exodus Global and its companies, BladeCore, Connect Work Tools, OilQuick Americas, RockZone Americas, and ShearCore, to verify and collect information on our company including but not limited to bank references. We also authorize these references to provide the requested information to Exodus Global and their companies without cost or obligation. In the event of default, we agree to pay all costs of collection and litigation regarding our account in accordance with the State of Wisconsin. All N.S.F checks will be subject to a $10.00 handling charge.
First Name
Last Name
Title
Date
Your Phone Number
Your Email
**INCOMPLETE APPLICATIONS CANNOT BE PROCESSED**
Form Completed By:
Title
Your Email
Date Completed
Send