APPLICATION FOR CREDIT TERMS WITH U.S. PHARMACOPEIA
NOTE: REQUIRED FIELDS ARE IN BOLD TYPE
Company Name:
Primary Bill-to Address:
USP Customer #:
(if known)
DUNS #:
(9-digit Company identification Code)
(U.S.) Tax Exempt #:
Years in Business:
Years at Present Location:
Do you issue Purchase Orders (POs)? o Yes o No
Anticipated Annual Purchases from USP:
Company’s Annual Sales Volume:
(USD)
(USD)
Has present firm (or principal) ever done business
under another name?
o Yes (name):
o No
Are you a subsidiary or division of another company?
o Yes (name):
o No
Bank Reference:
Address:
Account #:
Phone #:
Contact Person:
Credit References: List name, complete address, complete phone number
1)
2)
3)
4)
Contact Persons–at least one required
Accounts Payable (person responsible for payments):
Name:
Title:
Phone #:
Email:
Purchasing Agent:
Name:
Title:
Phone #:
Email:
I hereby certify that the information on this application is correct and permit USP to contact the references listed above to verify this
information. I also agree to pay promptly in accordance with USP Payment Terms: net invoice amount due in 30 days (Net- 30).
Authorized Signature:
Print Name:
Title:
Date:
Return to: Credit Manager, USP, 12601 Twinbrook Parkway, Rockville, MD 20852, U.S.A.
Fax: +1-301-998-6806 or email: jvt@usp.org.
A complete application will be processed within two business days.
