Credit Application

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Business Information
Company Name*
Billing Address*
Billing Address City State/Region Postal Code
Phone Number*
Billing Address is the same as Shipping Address
- Billing Address is the same as Shipping Address
Shipping Address
Billing Address City State/Region Postal Code
Phone Number*
P.O. Box #*
DUNS #*
Sales Tax Exempt #*
Credit Line Requested*
Primary contact info
Primary Contact Name*
Email*
Phone Number*
Account Payable Contact*
Account Payable Email*
Preferred payment method is ACH

Please email [email protected]
for banking information.

AG Technologies
Remit address : PO BOX 604225
Charlotte NC 28260-4225
[email protected]
704-526-1883 AR Team
Sales Rep Your’re Working With*
Business/Trade References
Company name*
Address 1*
Address 1 City 1 State/Region 1 Postal Code 1
Phone Number 1*
Company Number 1*
Company name 2*
Address 2*
Address 2 City 2 State/Region 2 Postal Code 2
Phone Number 2*
Company Number 2*
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