(800) 672-8536 [email protected]

Account Set Up Form

Account Set-Up Form

Thank you for chossing Chemtek, Inc.! We consider it a privilege that you have given us the opportunity to earn your business! Please fill out the Account Set Up Form Below. The information you provide will help us establish your company on an open account basis.

(This email address will be used for confirmation of form submittal)

Billing Contact Information
General Business Information

Maximum size 10MB


Maximum size 10MB

Ordering Information
Agreement & Signature
All accounts are COD until an account set up form has been submitted and approved. If any indebtedness incurred pursuant to this request for credit is not paid when due, the undersigned agrees to pay all costs of collection, including reasonable attorney's fees. Any balance so remaining unpaid shall bear interest at the lesser rate of 1.5% per month or the maximum rate permitted by applicable law, until paid in full.

Typing your electronic signature authorizes CHEMTEK, INC., to make any and all inquiries necessary to process this Credit Application

Please wait...