Section 1: Account Information
Section 2: Form Of Payment
Please Complete Section 3 of Credit Application If Checked “Open Account”
Section 3: Credit Application
In consideration of credit being extended by Eastman Products to the above named applicant for merchandise to be purchased whether applicant be an individual, partnership, corporation, or other entity, the undersigned hereby contract and guarantee to Eastman Products, Inc. the faithful payment, when due, of all account of said applicant. Application agrees to pay any collection cost incurred to collect the amount balance, including reasonable attorney’s fees. The undersigned warrants that the above information, and that the undersigned is an authorized agent for the above named applicant. Undersigned also acknowledges placement of a property lien for materials used and not paid for when due.
Please Fax or Email Sales Tax Exempt Certificate if Applicable
firstname.lastname@example.org or (317)-782-8577