Credit Application

	New Products

	Monthly Specials
	Liquidation Specials

	Search Catalog


	Español
	Team VCP
	News
	Features, Benefits and Testimonials
	Jobs Information
	Links & Resources
disclaimer

Customer Login

Click here to bookmark the page

On-Line Credit Application and Credit Agreement Form

Instruction: Please print or type, fill in all spaces and complete by “Submitting” where indicated. Submission is mandatory prior to receiving credit terms. If a corporation, the signature must be that of an officer or authorized agent. All information will be kept confidential.

Credit Application

*Customer Name:
*E-mail Address:
*Social Security Number:
*Phone Number:
*Fax Number:

*Billing Address:
*City:
*State:
*Zip Code:

*Shipping Address:
*City:
*State:
*Zip Code:

Business Type:
Specific Business Type:
Product Category:
Years In Business:
Corporate ID Number:
Number of Employees:
Division or Branch:
Parent Company:
*Principal Owners/Stockholders:
Credit Desired:

*Bank Reference:
*Bank Account Number (Checking):
*Bank Account Number (Credit):
*Bank Fax Number:
*City
*State:
*Zip Code:

*First Trade Reference:
*Address:
*City:
*State:
*Zip Code:
*Phone:
*Fax:

*Second Trade Reference:
*Address:
*City:
*State:
*Zip Code:
*Phone:
*Fax:

*Third Trade Reference:
*Address:
*City:
*State:
*Zip Code:
*Phone:
*Fax:

D&B:
If Yes, Duns #:
Person Authorized to Place Orders 1:
Person Authorized to Place Orders 2:
Person Authorized to Place Orders 3:

By submitting this form, the applicant agrees to recognize the folowing terms and conditions: Any claim or dispute arising from charges billed on the account must be asserted by applicant within 30 days from the invoice date or the billing records of VCP will thereafter be deemed accurate and irrefutable. Applicant will immeadiately notify VCP in writing of any change in the information on this application, including but not limited to changes of company name, address, ownership and legal status. We authorize VCP to obtain any further information from the references provided. Furthermore, we agree to pay invoices according to terms, plus a service charge of 1.5% per month on unpaid balances. Should it become necessary to place the account with a collection agency or attorney, the Applicant agrees to all collection costs and attorney fees in addition to all order sums due. the applicant warrants that the above agreement has been carefully read and that the applicant understands the same.

* Required Fields