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Credit Application

Credit Application

Please complete the form below to apply for terms of NET 30 Days.
  • Business Reference #1

  • (Please complete for expedited processing)
  • Business Reference #2

  • (Please complete for expedited processing)
  • Business Reference #3

  • (Please complete for expedited processing)
  • I agree to allow DeGroot, Inc. to request references from the business references provided in this form. To my knowledge, the information supplied in this form is correct and true. I understand that I am applying for terms of Net 30 days and if approved, I will be subject to 1.5% interest per month on overdue accounts. (By entering your full name in the box provided, you confirm that this serves as your electronic signature.)
  • Date Format: MM slash DD slash YYYY