WAUSAU CHEMICAL CORP   CONFIDENTIAL   CREDIT APPLICATION
2001 N River Drive
Wausau WI 54403
PO Box 953
Toll Free 800.950.6656
Phone No 715.842.2285
Fax No 715.842.9059
Business Information
Billing Name: Billing Address:
Billing City: Billing State & Zip:
County: Years in Business:
Business Activity: Email Address:
Business Phone: Business Fax:
Amount of credit Applying for:$ Federal ID#:
If exempt from sales tax, please attach exemption certificate for your state.
Delivery Information
Delivery Address: Delivery Hours:
Delivery City: Delivery State & Zip:
Delivery Directions:
Principals of Organization
Name: Title:
Soc.Sec. #: Home Phone:
Home Address: City, St, Zip:

Name: Title:
Soc.Sec. #: Home Phone:
Home Address: City, St, Zip:
Bank References
Bank Name: Contact:
Address: Phone No:
City, State, Zip: Fax No:
Trade References
Name: Contact:
Address: Phone No.:
City, State, Zip: Fax No.:

Name: Contact:
Address: Phone No.:
City, State, Zip: Fax No.:
TERMS: Net 30 days from date of invoice. All orders will be shipped COD unless prior credit has been established. Accounts and balances unpaid beyond our normal terms are subject to a 1.5% per month service charge (18% annual). Minimum service charge is $1.00 per month.
I hereby authorize Wausau Chemical Corp or any credit reporting agency employed by them to investigate the references herein listed or any of the other information stated above to determine my qualifications for a credit account.

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