Valin Corp: Tube & Pipe Fittings, Industrial Valves, High Purity Valves, Process Controls, Gauges

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Registration

Existing Valin Customer

Credit Application

Please complete all information below.
An incomplete application will cause a delay in processing.
Your information will be kept private, for use by Valin only.

* denotes required information.

Billing Information
Company Name	*
Address 1:	*
Address 2:
City:	*
State/Province:	*
Zip Code/Postal Code:	*
Contact Name:	*
Phone:	*

Shipping Information
Company Name:	*
Address 1:	*
Address 2:
City:	*
State/Province:	*
Zip Code/Postal Code:	*
Contact Name:	*
Phone:	*

Company Information
Type of Company:	*
Years in Business:	*
Years at Present Address:	*
Number of Employees:	*
Type of Business(describe):	*
Federal ID Number:	*
Requesting Credit Line of ($):	*

Tax-Exempt Status

If the items purchased are shipped to destinations in California or Nevada, applicable sales tax applies unless the items qualify for resale. If resale tax exemption is applicable, check the box below.

	Some or all items will be for resale in California/Nevada

A valid Resale Certificate and Number is required to be on file with Valin. If you do not have one on file with Valin, please download and fill out the Resale Certificate form, and fax it to Valin at 408-730-1363. Sales tax will be charged until your certificate is received.

Officers, Partners, Or Owners
Name:	*
Title:	*
SSN:	*

Name:
Title:
SSN:

Agreement

It is understood and accepted by the undersigned that:

All invoices are due and payable on a net 30 day date of invoice basis.
Any amounts not paid within the terms may be subject to a late charge of 1.5% per month, APR:18%.
In the event suit is required to enforce collection of unpaid balances, customer agrees to pay reasonable collection and/or attorney's fees and all court costs.
A facsimile copy of this document is to have the same force and effect as the original.

By completing this credit application and clicking on "I Accept & Submit", the undersigned certifies that he/she is authorized to submit this agreement.

Contact Name:

Title:

E-mail:

Date: