Credit Application
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ChimTech, LLC
PO Box 3285
Missoula, MT 59806

Phone:
Fax:
Email: info@skin-protection.com
Firm Name: Date:
Mailing Address: Phone: (            )
. Fax: (            )
Shipping Address: Current Location Since:
. State Resale Tax #:
Type of Business: .
Bank Name: .
Address: Account #:
. Acct Opened:
Phone: (            ) Any Loan?
Fax: (            ) Amt of Loan:

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Phone: (            ) Phone: (            )
Fax: (            ) Fax: (            )
Acct. Opened: High Credit: Acct. Opened: High Credit:
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Terms: Terms:
Name: Name:
Address: Address:
. .
Phone: (            ) Phone: (            )
Fax: (            ) Fax: (            )
Acct. Opened: High Credit: Acct. Opened: High Credit:
Manner of Payment Manner of Payment
Terms: Terms:


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