Business Credit Application

Complete your application in a few quick steps. We currently only accept credit applications from companies based in the United States.

Your Contact Information

First Name*

First name is required.

Last Name*

Last name is required.

Position / Title

Phone Number*

Phone number is required.

Email Address*

A valid email is required.

Lab Alley Employee Contact (if applicable)

Company Information

Company Name*

Company name is required.

Company Type*

Please select a company type.

Industry*

Please select an industry.

Street Address*

Street address is required.

Suite / Unit Number

Country*

City*

City is required.

State / Province*

Please select a state/province.

Zip / Postal Code*

Zip/postal code is required.

Business Phone Number*

Business phone is required.

Business Website

Number of Employees

Secondary Purchasing Contact

Schools & universities must provide a second person authorized to purchase on this account.

Name*

Name is required.

Email*

A valid email is required.

Phone*

Phone is required.

Additional Authorized Purchasers

Anyone else at your company who should be authorized to place orders on this account.

Financial Information

Federal Tax ID*

Federal Tax ID is required.

Dun & Bradstreet #

State Incorporated

Years Since Incorporation

Company Valuation (USD)

Requested Credit Amount*

Requested credit amount is required.

Tax Exemption

Is your company tax exempt?Is your institution tax exempt?*

Payment Portal

Does your company use a payment portal?Does your educational institution use a payment portal?*

Invoice Email Address*

Invoice email is required.

Business Description

Briefly describe your business & the products you intend to purchase

Bank Reference

Bank Name*

Bank name is required.

Phone Number*

Bank phone is required.

Bank Address*

Bank address is required.

Country*

City*

Bank city is required.

State / Province*

Please select a state/province.

Zip Code*

Bank zip is required.

Trade References

A minimum of three trade references is required.

Please upload your trade reference document (required).

Review Your Application

Digital Signature

Type your full legal name to sign*

Signature is required.

Date

I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge, and I authorize Lab Alley to verify this information with the references and financial institutions listed above.

Please certify the information above before submitting.

Please confirm the checkbox above.