Credit Account Application | Wagner Flow

Requirements for Net 30 Terms

Valid business with verifiable trade references
Completed credit application
W-9 Form (required for all accounts)
Tax Exemption Certificate (if applicable)
Minimum order requirements may apply

Business Information

Company Name *

DBA / Trade Name (if different)

Years in Business *

Federal Tax ID / EIN *

Business Type *

Business Address *

City *

State *

ZIP Code *

Business Phone *

Fax Number

Company Website

Primary Contact

Contact Name *

Title

Email *

Direct Phone

Accounts Payable Contact

AP Contact Name *

AP Email *

AP Phone *

Purchase Orders Required?

Credit Information

Monthly Credit Limit Requested

Estimated Monthly Purchases

Trade References

Please provide at least two trade references

Reference 1 *

Company Name

Contact Name

Phone

Reference 2 *

Company Name

Contact Name

Phone

Reference 3 (Optional)

Company Name

Contact Name

Phone

Required Documents

W-9 Form *

Upload your completed W-9 form (PDF, DOC, or image format)

Download blank W-9 from IRS.gov

Is your company tax exempt?

Resale Certificate (Optional)

Upload if purchasing for resale

Terms & Conditions

Payment Terms: Net 30 days from invoice date. A 1.5% monthly finance charge (18% annually) will be applied to past due accounts.

Credit Limit: Wagner Flow reserves the right to set, modify, or revoke credit limits at any time based on payment history and credit evaluation.

Personal Guarantee: For new accounts, a personal guarantee may be required from an officer or owner of the company.

Authorization: By submitting this application, you authorize Wagner Flow to obtain credit information from the references provided and from credit reporting agencies.

I certify that all information provided is true and accurate. I have read and agree to the terms above and authorize Wagner Flow to verify this information. *

Print Name (as signature) *

Title *

Date *

Applications are typically reviewed within 2-3 business days. You will receive an email confirmation upon submission and notification of approval status.