Credit Application

Business Credit Application

  • Phone: 425-222-5963
  • Toll Free: 888-345-4858
  • Fax: 425-222-6030
QuickMedical, P.O. Box 7271
Warwick, RI 02887
Company Information
Contact Information
Business and Credit Information
Have You had Credit with us Before?
Are You Tax Exempt?
Must be state recognized tax exempt certificate.
Chief Corporate Officers or Partners
Accounts Payable Contact Information
Business / Trade References
Bank References
I represent that the above information is true and is given to induce QuickMedical to extend credit to the applicant. My company and I authorize QuickMedical to make such credit investigation as QuickMedical sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to QuickMedical any and all information concerning the financial and credit history of my company and myself.
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