Westech Seal, Inc™: Form

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Westech Seal, Inc.™

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Mailing Address

P.O. Box 14610

Odessa, TX 79768

Physical Address

7200 Sprague

Odessa, TX 79764

Toll-Free (800) 242-2431

Work (432) 367-1188

Fax (432) 362-2347

Contact Information
Business Name:
Phone:
Fax:
Email:
Website:

Billing Information
Billing Address:
City:
State:
Zip:

Shipping Information
Shipping Address:
City:
State:
Zip:

Payables Contact
Name:
Phone:
EMail

Purchasing Contact
Name:
Phone:
EMail:

Officers or Principles
If applicant has been in business less than (2) years, please provide the past employment for the principles and/or officers with this application.
Name (Officer 1):
Title (Officer 1):
Name (Officer 2):
Title(Officer 2):
Have principles filed or been associated with a business that filed bankruptcy in the last 5 years?	Yes \| No

Businss Information
Nature of business:
Years in Business:
Business Type:	Corporation Partnership Proprietorship LLC Government
Federal ID
D&B
Subsidiary of:
Sales Tax payable:	Yes \| No (We will need a signed resale or exempt certificate)
Please check the products that your company uses:	Mechanical Seals / Repair Parts Rotary Assemblies Bellow Seals INPRO Isolators Springs TRICO Products Glands, Shafts, & Sleeves Carbon Bushings

Application for Commercial Credit Account