WinSynergy Chemical – Credit Application

Customer Information

(* indicates required field)

Principal Owners and Officers

Trade References (List 3 Major Suppliers)

Bank References

Exemption Status

(Please also email a copy of your tax exempt certificate)

Agreement

I, (we) certify that this information is true and correct and I, (we) give WinSynergy Chemical, LLC permission to contact any credit reporting agency, including the bank and trade references given and that any extension of credit shall be subject to the following terms and conditions:

1. Applicant affirms that it is authorized to do business within the State of Texas.

2. I, (we) shall pay the full amount of the invoice when due, which is defined as 30 days from the invoice date unless otherwise specified.

3. By typing their name, Applicant affirms that they have the authority to apply for credit on behalf of their firm.

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