Credit Application - ZIRCAR Ceramics, Inc.

NOTICE - please be aware that due to the recent Supreme Court Wayfair decision, ZIRCAR Ceramics is now taking steps to ensure that we comply with all state and local tax regulations. When completing your credit application online, please upload your tax exempt form. If none is attached, we must assume one does not exist and we will therefore need to collect applicable taxes.

Please Attach Tax Exempt Form Here

Max. file size: 128 MB.

Thank you for your interest in doing business with ZIRCAR Ceramics, Inc. As it is your desire to establish credit with our company we are providing this e-form to help facilitate your application for credit. Please provide the requested information, when complete, click on SUBMIT. Your Application for Credit will be processed promptly. Please keep in mind the decision to grant credit will be influenced by the pace and content of the responses we receive from the references provided. Should you wish to fill in a form by hand , please CLICK HERE for a printable form. Please return the completed form to :

ZIRCAR Ceramics, Inc.
100 North Main Street
Florida, NY 10921
Telephone +1 845 651 6600
Telefax +1 845 651 0441
e-mail sales@zircarceramics.com

Part 1: CUSTOMER INFORMATION

Applicant/Company Name*

Accounts Payable Contact*

First Last

Title*

Phone*

Fax

Your Email Address*

Email Address Confirm Email Address

Preferred Method of Contact*

Best Time to Call You

BILLING ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Fed ID#*

Incorporated?*

No
Yes

Year Incorporated

State/Country Incorporated

Subsidiary?*

No
Yes

Parent Company Name

Parent Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Part 2: TRADE REFERENCES
Include information on three (3) firms which you currently purchase from in quantities comparable to the level of credit you are requesting. Alternatively, you may upload reference sheets below.

File

Drop files here or

Max. file size: 128 MB.

TRADE REFERENCE #1

Company Name

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name

First Last

Title

Email

Phone

Fax

TRADE REFERENCE #2

Company Name

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name

First Last

Title

Email

Phone

Fax

TRADE REFERENCE #3

Company Name

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name

First Last

Title

Email

Phone

Fax

Part 3: CERTIFICATION & AUTHORIZATION

By checking below, I certify that:

- I am applying for credit with ZIRCAR Ceramics, Inc (ZCI) and that the above information is correct.
- All orders placed with ZCI shall be subject to ZCI’s “Terms and Conditions of Sale”.
- I have read ZCI’s “Terms and Conditions of Sale” in its entirety and agree to abide by all its contents. Specifically (unless other arrangements are agreed upon by ZCI Management), payments will be made for each invoice within thirty (30) days from Invoice Date, late payments will be subject to a 1.5% per month finance charge and the applicant shall reimburse ZCI for any expenses incurred in collecting delinquent funds owed.
- I grant ZCI permission to conduct a credit investigation. In doing so, ZCI may contact the trade references and bank listed above for any and all financial information related to the applicant as well as utilize reports from other agencies.
- I have the authority to commit the above named applicant to the terms of this agreement.

Name*

First Last

Title*

Date*

You must agree to the above to submit your application.*

Disagree
Agree