Company Application Information Billing Address Shipping Address (Check if same as billing) Parent Company (if applicable): Business Contact Information Ownership: Corporation Partnership Proprietorship Sales Tax Exempt # (please email certificate to AR@icbiomedical.com ) Taxable (please provide sales tax rate): Bank References Trade References I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein Please use the below contact form if you have any questions
