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Credit application
Full name
*
Email
*
Company legal name
*
Phone number
*
City, ST Zip
*
Shipping/Logistics Contact Person
*
Tax ID
*
Accounts payable contact name
*
Accounts payable phone
*
Accounts payable email
*
Fura Representative Name
*
Credit limit amount requesting:
*
Invoicing preferences
*
Please select
Email
Portal
Integration (api)
Do you require POD?
*
Please select
Yes
No
Do you have any special shipping or billing instructions?