Nutra-Flo® Company
1919 Grand Avenue -- Sioux City, Iowa 51106-5708 -- Ph: 712-277-2011 -- Fax: 712-279-1946
The following information will be kept in strict CONFIDENCE and will be used
only for the purpose noted.
Online Application for Credit
Business Name Date
Address City
State Zip
Phone Fax
If company, type of ownership: Corporation    Partnership    Individual
Federal ID Number
Owner's or Principal's Names:
   Name   Title  SSN
   Name   Title  SSN
   Name   Title  SSN
State Incorporated Year
Are there any other company names?
How long have you been in business? Desired Credit Limit?
Years at your present address
Type of Business Number of employees?
Have you ever filed a personal or business bankruptcy? Yes    No
   SIC Code D&B Number
Are purchase orders required? Yes    No
Person to contact regarding Accounts Payable
Recent Financial Statement is Required:
   Bank Reference #1
Bank Name Address
City, State, Zip
Phone Banker's Name
   Bank Reference #2
Bank Name Address
City, State, Zip
Phone Banker's Name
Business references you have been recently doing business with:
Name Address
City, State, Zip Phone
Name Address
City, State, Zip Phone
Name Address
City, State, Zip Phone
I (we) understand that the information furnished you on this page is for the purpose of obtaining credit from your firm. That I am (we are) authorized in my (our) capacity, to bind my (our) firm accordingly. All accounts or monies due shall be due and payable at your place of business. I (we) will be personally responsible for any debts incurred.

Terms and Conditions: Terms are net due 15 days from the invoice date. On past due invoices, a late payment charge of 2% will be assessed on the unpaid balance. After 30 days, a service charge of 1½% per month will be charged on all past due balances. In no event will finance charges exceed maximum permissible by law.

<< Back