Credit Application Form

Carolina Biological Supply Company Credit Application Form

If your school or business would like to apply for a line of credit with Carolina, please fill out the application below. A representative will contact you within 10 days of your application to discuss the terms of your credit line.

School / Business Name*

School / Business Address Information*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Financial Officer or Accounts Payable Contact Person

First Name

Last Name

Primary Phone Number*

Fax Number

Email Address

Trade Reference #1

Company Name*

Address Information*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Contact Name

First Name

Last Name

Primary Phone Number*

Fax Number

Email Address

Trade Reference #2

Company Name*

Address Information*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Contact Person

First Name

Last Name

Primary Phone Number*

Fax Number

Email Address

Trade Reference #3

Company Name*

Address Information*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Contact Person

First Name

Last Name

Primary Phone Number*

Fax Number

Email Address

Bank Reference Information

Bank Name*

Address Information*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Contact Person

First Name

Last Name

Primary Phone Number*

Fax Number

Email Address