Credit Application

To submit your form, please follow these steps:

Fill out the form below.
Click the Download button at the bottom of the form.
Print out the downloaded document and sign it.
Email the signed copy back to us at [email protected].

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Business Contact Information

Company Name

Business Type

Sole Proprietorship Partnership Corporation Other

Date Business Began

Contact Name

Registered Company Address / City, State, ZIP Code

Phone

Fax

Contact Email

Federal ID# (EIN)

DUNS#

Billing Contact

Billing Email

Business / Trade References

Trade Reference 1

Company Name

Phone

Address / City, State, ZIP Code

Fax

E-mail

Account#

Trade Reference 2

Company Name

Phone

Address / City, State, ZIP Code

Fax

E-mail

Account#

Trade Reference 3

Company Name

Phone

Address / City, State, ZIP Code

Fax

E-mail

Account#

Banking Information

Bank Name

Bank Contact Name

Physical Address / City, State, ZIP Code

Mailing Address / City, State, ZIP Code

Phone

Fax

E-mail

Length of time as account holder

Agreement

Payment Terms

Currency: All accounts are payable in U.S. funds.

Deadlines: All payments are due in full within NET 30 days of the invoice date unless otherwise agreed in writing.

Application of Funds: Pack Secure reserves the right to apply incoming payments to the oldest outstanding balances first.

Credit and Account Status

Credit Approval: Purchaser's financial responsibility is subject to continuous approval by the Pack Secure Credit Department.

Account Suspension: If Pack Secure determines that the Purchaser’s financial standing is impaired, we reserve the right to cancel orders, halt shipments, or require payment in advance.

Credit Reporting: Account payment performance may be reported to Dun & Bradstreet.

Disputes, Late Fees and Collections

Invoice Disputes: Any claims or inquiries regarding invoices must be submitted within seven (7) working days of receipt. Please fax inquiries to 888-905-0020 or email [email protected].

Late Fees: Delinquent balances may be assessed a late charge of 2% per month.

Collection Costs: In the event of a payment default, the Purchaser agrees to pay all attorney and/or collection agency fees incurred to recover the past-due balance.

Warranties and Liability Limitations

Manufacturer Warranties: Products are covered strictly by their respective manufacturer’s warranty.

No Express/Implied Warranties: Pack Secure provides no additional warranties, express or implied, regarding product fitness for a particular purpose, merchantability, design, or performance. No warranty is binding unless signed by an authorized Pack Secure representative.

Liability: Pack Secure is not liable for any consequential or incidental damages.

Account Maintenance

Information Updates: Customers must provide prompt written notice of any changes to their billing address, fax number, or email address to ensure seamless invoice delivery streams.

I understand that the information furnished to Pack Secure is for the purpose of requesting credit from your firm, and that I am authorized, in my capacity, to bind my firm accordingly. I hereby authorize the banks, secured parties, trade references and others listed above to release information regarding our accounts.

By signing below I/We agree to the above terms. (Manual Signature required - No E-Signatures)

Authorized Signature

Name and Title

Date