Credit Application

To apply for open credit terms with Pathway Polymers, please complete and submit our credit application.  Pathway Polymers will inquire with your bank and the three credit references that you supply in determining whether to extend open credit. Our credit analysts will review your application and respond to you as quickly as possible.

Thank you for your interest in becoming a Pathway Polymers TyrFil Dealer and we look forward to welcoming you to our Dealer Network.

Application for Credit

Your Company Information
Company Name
Company Billing Address
City
State
Zip Code
Country
Company Contact First Name
Company Contact Last Name
Phone
Fax
E-Mail
Company Shipping Address
Same as Billing Address?	Yes No
Company Shipping Address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Accounts Payable Contact
Same as Company Contact?	Yes No
Accounts Payable Contact First Name
Accounts Payable Contact Last Name
Accounts Payable Phone
Accounts Payable Fax
Accounts Payable E-Mail
Tax Exempt?	Yes No
Please attach a copy of your tax exempt certificate
Federal ID Number, or if sole propriertorship, owner`s Social Security Number
Requested Credit Amount (in dollars). Standard terms are Net 30 days from date of invoice.
Bank Information
Please select your bank`s country	United States Canada
Bank name
Bank account number
Bank address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Bank Contact Person
Bank Contact Phone
Bank Contact Fax
Credit References
Credit Reference #1- REQUIRED
Please select Country for Reference #1	Select One United States Canada
Reference Company Name	Select One
Reference Company Address
Refererence City
Reference State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Reference Zip Code
Reference Contact Person
Reference Contact Phone
Reference Contact Fax
Credit Reference #2- REQUIRED
Please select Country for Reference #2	Select One United States Canada
Reference Company Name
Reference Company Address
Refererence City
Reference State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Reference Zip Code
Reference Contact Person
Reference Contact Phone
Reference Contact Fax
Credit Reference #3- REQUIRED
Please select Country for Reference #3	Select One United States Canada
Reference Company Name
Reference Company Address
Refererence City
Reference State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Reference Zip Code
Reference Contact Person
Reference Contact Phone
Please Enter Code Into the Textbox Below (CODE IS CASE-SENSITIVE):

The information provided is true and correct. By clicking "submit" I grant Pathway Polymers permission to perform a check with the above referenced bank/financial institution and trade references.