Innovative Research Technologies Credit Application

To establish credit terms please fill out this form and click the submit button below OR you may print this form and fax completed information to (817) 677-3038.

The Name of Your Company
Your Name
Your Title
Your Email Address
Your Work number
Your Fax number
Mailing Address
What Does Your Company Do?
Bank references.
Name of your Bank
Phone number of your Bank
Bank account number
Bank address
Trade references.
Please provide us with up to 3 references with which you have had payment terms with.
Company #1
Contact name
Contacts phone number
Company #2
Contact name
Contacts phone number
Company #3
Contact name
Contacts phone number
Level of credit desired
Any comments you may have.

[Return to homepage]