Needle.Tube Purchase Order Application

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Thank you for your interest in a credit line with Needle.Tube. Please complete the following simple form below and submit. You may optionally include a purchase order. We will perform a speedy review and get back to you as soon as possible! Need help? Call (724) 497-2188.

If you're already approved for credit, please email your purchase order(s) to team@needle.tube

Cheers! - Team@Needle.Tube

Company or Entity Name *

Address
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Website
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Phone Number
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Fax Number
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Type of Business (retail, government, healthcare, manufacturing, etc.)
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Year Established
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Last Year's Revenue (approximate)

Number of Employees (approximate)
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Type Of Entity
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Are you Tax Exempt?
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Federal Tax ID Number

Dun & Bradstreet Number (D&B)

Anticipated Annual Purchase Volume ($)
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Amount of Credit line Requested ($)
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Accounts Payable Contact (First Name and Last Name)

Accounts Payable Contact
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Email of Accounts Payable Contact
*

Accounts Payable Phone Number
*

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