Net 30 Terms Application Form

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Apply for Net 30 Day Terms of Purchase

We extend credit as a service to customers with an acceptable credit rating. We offer Net 30 Terms. The process normally takes 3-5 business days for us to complete. We will notify you whether you are approved or disapproved. IF you are approved, you will see the option to checkout using “Net 30 Terms” on the checkout page.

* You MUST be registered on Elimstat.com to apply for terms. IF you have not registered, please do so now here.

My Name*
First Last
My Job Title*
My Company*
My Phone Number*
Accounting Department Phone Number*
My Email Address*
Is this the Email Address to submit invoices to?*
- Yes
- No
Email Address to Send Invoices To*
My Company's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
My Fax Number
Credit Reference #1 Company Name*
Credit Reference #1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account # with Credit Reference 1 (if available)
Credit Reference #1 Contact Name
Credit Reference #1 Phone Number*
Credit Reference #1 Email*
Credit Reference #1 Fax Number
Credit Reference #2 Company Name*
Credit Reference #2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account # with Credit Reference 2 (if available)
Credit Reference #2 Contact Name
Credit Reference #2 Phone Number*
Credit Reference #2 Email*
Credit Reference #2 Fax Number
Credit Reference #3 Company Name*
Credit Reference #3 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account # with Credit Reference 3 (if available)
Credit Reference #3 Contact Name
Credit Reference #3 Phone Number*
Credit Reference #3 Email*
Credit Reference #3 Fax Number
Bank Reference*
Bank Account #*
Bank Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Email*
Bank Phone Number*
Bank Fax Number

Apply for Net 30 Day Terms of Purchase

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