US Credit Application

US Credit Application

Credit and Tax Exempt Application - Please be accurate, this is a legal document.
Submission Date Submission Date / MM / DD YYYY
Your Name Your Name First Last
Accounts Payable Phone Accounts Payable Phone - ### - ### ####
Your Email Address *
Official Company Name *
State Tax ID Number *
Company Address Company Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Certification *

Certification I/We Certify that the above information is true to the best of our knowledge. I/We Certify that we are a nontaxable entity and the products we buy from Primal23 Industrial LLC and www.primal23industrial.com are tax exempt or for resale. I/We Accept Primal23 Industrial LLC and www.primal23industrial.com - Terms of Use I/We agree to pay all Credit Invoices within 30 days from date of issue.
Authorization *

Authorization I am an Authorized Authority, Shareholder or Manager of the Company named above.
Electronic Signature *
Primal23 Industrial LLC

30 N Gould St
Suite 7645
Sheridan, Wyoming 82801

Telephone - 855-673-1164
Email - AR@primal23industrial.com