Credit Application Form

Please, fill out our Credit Application Form in MS Word Document Format and FAX it to us at +971 4 369 7110. Meanwhile, fill out the form below as part of the application process to investigate your records.
Final decision does not take place until the application is FAXED.

 

 

Company Name
Company Address
Telephone
FAX
Email
Delivery Address
Authorized Purchaser 
Name
Designation
Trade License Number
Bank Account Details
Power of Attorney Designate Person
Name
Position
Estimated Purchase
Company Type
(if others kindly mention)
Company Classification
(if others kindly mention)
Products
Market Covered
Aptec Distribution Sales Contact

  

 

Download Credit Application Terms & Conditions

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