Credit Application Form

APPLICATION FOR CREDIT

There are just 3 simple steps to applying for an account with Factory Direct Pipeline Products, Inc.. Click Here for a PDF version that can be printed and faxed.

Section I: Company Information
Company Name:
Complete Address:
Phone #:
Fax #:
Primary Contact:
Email Address:
Federal ID or Social Security #:
Section II: Banking Information
Name of Bank:
Complete Address:
Account #:
Contact:
Phone #:
Fax#:
Section III: References
A.	Company Name:
	Phone#:
	Fax#:
	Contact:
B.	Company Name:
	Phone#:
	Fax#:
	Contact:
C.	Company Name:
	Phone#:
	Fax#:
	Contact:

By submitting this form you certify that: 1 all the information filled in above is accurate and correct. 2 You fully understand and agree to the proper payment in consideration of extended credit and further agree to all terms and conditions as stated on the Factory Direct Pipeline Products Inc. website www.fdpp.com. 3 Specifically, you agree to pay all invoices based upon the following payment terms: 3% 10 net 30 days. 4 You authorize the typed signature below to substitute as your hand-written signature to be used for obtaining information from your bank.

Signed and Agreed to by:

Today's Date:

FACTORY DIRECT PIPELINE PRODUCTS, INC. Your Single Source for Industrial Filtration and Valve Products Copyright 2001-2008	phone:	908.496.9020 x-302	Accept Credit Cards Online
	fax:	908.496.8080
	email:	fdpp@fdpp.com