FloWorks International Credit Application

Legal Company Name(Required)

Select Floworks Business Unit(Required)

Please Select Business Type(Required)

FloWorks Salesperson Name(Required)

DBA

Street Address(Required)

City(Required)

State/Province(Required)

Zip Code(Required)

Mailing Address

Street Address(Required)

City(Required)

State/Province(Required)

Zip/Postal Code(Required)

Country(Required)

Main Telephone Number(Required)

Main Fax Number

Email Address(Required)

Contact Informtion

A/P Contact(Required)

A/P Email Address(Required)

A/P Telephone Number(Required)

A/P Fax Number(Required)

Business Start Date

Dun & Bradstreet #

Federal Tax ID #(Required)

Credit Line Requested

Method of Payment(Required)

Please attach any pre-printed documents below. Send wire payment information to remittance@floworkspvf.com.

Company Website

Name of Business Owner(s)/Officiers(s)

Type of Business(Required)

Bank Reference

Attach all the pre-printed references below.

Bank Name

Bank Contact Name

Bank Address

Bank Telephone Number

Bank Account Number

Bank Fax Number

Bank Email Address

Trade References (3 references required)

Attach all the pre-printed references below.

Trade Reference 1

Contact Name

Street Address

City

State/Province

Zip/Postal Code

Main Number

Fax Number

Email Address

Trade Reference 2

Contact Name

Street Address

City

State/Province

Zip/Postal Code

Main Number

Fax Number

Email Address

Trade Reference 3

Contact Name

Street Address

City

State/Province

Zip/Postal Code

Main Number

Fax Number

Email Address

I agree to the privacy policy.

We hereby represent that we are authorized to submit this application on behalf of the Buyer named herein, for the purpose of obtaining credit, and that the information (including any requested financial statements) provided to Floworks International LLC and/or its subsidiaries and affiliates (collectively, “Seller”) is warranted to be true, accurate and complete. We hereby authorize Seller to request credit reports from credit bureaus (including consumer reporting agencies) regarding Buyer’s respective commercial credit and to otherwise investigate their respective creditworthiness before extending credit now or at any time in the future. We further represent that the Buyer has the financial ability, solvency, and capability to pay for all invoices within the agreed upon terms. Unless otherwise agreed in writing, Buyer agrees to Seller’s payment terms of net 30 days from invoice, payable in U.S. dollars. Buyer agrees that all Terms and Conditions of Sale, attached below, may be amended from time to time, and shall apply to all sales and extensions of credit made to Buyer by Seller. All information obtained is kept confidential by Seller.

Do you accept these terms?(Required)

Print Your Name(Required)

Today's Date

Attachments

Accepted file types: jpg, pdf, png, Max. file size: 10 MB.

For all questions or concerns, please contact CreditTeam@floworkspvf.com.