welchpkg.dev.ibsinternet.com
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50.247.178.138
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URL:
https://welchpkg.dev.ibsinternet.com/
Submission: On March 19 via api from US — Scanned from US
Submission: On March 19 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
POST /
<form enctype="multipart/form-data" action="/" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token"
value="7fP8fhLGpsOLasZ+MM7xdm/mwSZfagQkej3hZByPqaxBQ0VaFE6CtxCyph8m3x/lFJb+XQfC4SHL/r8Bw99oyw==">
<!-- Your Name -->
<div>
<label for="name">Your Name: </label>
<input type="text" name="name" id="name">
</div>
<!-- Your Email -->
<div>
<label for="email">Your Email Address: </label>
<input type="text" name="email" id="email">
</div>
<!-- Company Name -->
<div>
<label for="company">Company Name:</label>
<input type="text" name="company" id="company">
</div>
<!-- Company Address -->
<div>
<div class=" street">
<label for="company_address">Company Address:</label>
<input type="text" name="company_address" id="company_address">
</div>
</div>
<div class="address">
<div>
<label for="company_city">City:</label>
<input type="text" name="company_city" id="company_city">
</div>
<div>
<label for="company_state">State:</label>
<input type="text" name="company_state" id="company_state">
</div>
<div>
<label for="company_zip">Zip:</label>
<input type="text" name="company_zip" id="company_zip">
</div>
</div>
<!-- Billing Address same as above -->
<div>
<div class=" street">
<label for="billing_address_same">Billing Address same as above:</label>
<input type="checkbox" name="billing_address_same" id="billing_address_same" value="same" checked="checked">
</div>
</div>
<!-- Billing Address -->
<div class="billing" style="display: none;">
<div class=" street">
<label for="billing_address">Billing Address:</label>
<input type="text" name="billing_address" id="billing_address">
</div>
</div>
<div class="address billing" style="display: none;">
<div>
<label for="billing_city">City:</label>
<input type="text" name="billing_city" id="billing_city">
</div>
<div>
<label for="billing_state">State:</label>
<input type="text" name="billing_state" id="billing_state">
</div>
<div>
<label for="billing_zip">Zip:</label>
<input type="text" name="billing_zip" id="billing_zip">
</div>
</div>
<!-- Company Phone -->
<div>
<label for="company_phone">Company Phone:</label>
<input type="text" name="phone" id="phone" class="phone">
</div>
<!-- Company Fax -->
<div>
<label for="company_fax">Company Fax (optional):</label>
<input type="text" name="fax" id="fax" class="phone">
</div>
<!-- Business Type -->
<div>
<label for="business_type">Type of Business: </label>
<select name="business_type" id="business_type">
<option value="S-Corp">S-Corp</option>
<option value="LLC">LLC</option>
<option value="Partnership">Partnership</option>
<option value="Sole Proprietor">Sole Proprietor</option>
<option value="C-Corp">C-Corp</option>
</select>
</div>
<!-- Federal ID Number -->
<div>
<label for="federal_id_number">Federal ID Number: </label>
<input type="text" name="federal_id_number" id="federal_id_number" maxlength="10" class="id-number">
</div>
<!-- Annual Sales -->
<div>
<label for="annual_sales">Estimated Annual Sales with Welch Packaging: </label>
<input type="text" name="annual_sales" id="annual_sales">
</div>
<!-- Business Start Date -->
<div>
<label for="business_start_date">Date Business Started:</label>
<input type="text" name="business_start_date" id="business_start_date" placeholder="mm/dd/yyyy" class="datepicker hasDatepicker">
</div>
<!-- Welch Location -->
<div>
<label for="location_id">Welch Location: </label>
<select name="location_id" id="location_id">
<option value="">Select a Location</option>
</select>
</div>
<!-- Tax Exempt -->
<div>
<label for="tax_exempt">Tax Exempt: </label>
<div class="radio">
<input type="radio" name="tax_exempt" id="tax_exempt_yes" value="yes"><label for="tax_exempt_yes">Yes</label>
<input type="radio" name="tax_exempt" id="tax_exempt_no" value="no" checked="checked"><label for="tax_exempt_no">No</label>
</div>
</div>
<!-- Exemption Certificate -->
<div style="display: none;">
<label for="exemption_certificate">Tax Exempt Certificate Upload: </label>
<input type="file" name="exemption_certificate" id="exemption_certificate">
</div>
<!-- Terms -->
<div>
<label for="terms">This application is for: </label>
<div class="radio">
<input type="radio" name="terms" id="terms_Credit_Terms" value="Credit Terms"><label for="terms_Credit_Terms">Credit Terms</label>
<input type="radio" name="terms" id="terms_Credit_Card_Terms" value="Credit Card Terms"><label for="terms_Credit_Card_Terms">Credit Card Terms</label>
<input type="radio" name="terms" id="terms_Cash_in_Advance" value="Cash in Advance"><label for="terms_Cash_in_Advance">Cash in Advance</label>
</div>
</div>
<!-- CC Form Download -->
<div class="cc_terms_form" style="display: none;">
<label>Credit Card Information:</label>
<span>Please download this <a target="_blank" href="https://welchpkg.dev.ibsinternet.com/welchpkg_cc_form.pdf">Credit Card Form</a> if you choose credit card terms.</span>
<label> </label>
<button type="button" onclick="window.open( 'https://welchpkg.dev.ibsinternet.com/welchpkg_cc_form.pdf' );">Download Form</button>
</div>
<!-- Invoice Method -->
<div>
<label for="invoice_method">Invoice Method: </label>
<select name="invoice_method" id="invoice_method">
<option value="Email">Email</option>
<option value="Fax">Fax</option>
<option value="Mail">Mail</option>
</select>
</div>
<div>
<label for="invoice_email">Invoice Email Address: </label>
<input type="text" name="invoice_email" id="invoice_email">
</div>
<div style="display: none;">
<label for="invoice_fax">Invoice Fax Number: </label>
<input type="text" name="invoice_fax" id="invoice_fax">
</div>
<!-- Accoutns payable information -->
<h2>Accounts Payable Information</h2>
<div>
<label for="accounts_payable_name">Accounts Payable Contact Name: </label>
<input type="text" name="accounts_payable_name" id="accounts_payable_name">
</div>
<div>
<label for="accounts_payable_email">Accounts Payable Contact Email: </label>
<input type="text" name="accounts_payable_email" id="accounts_payable_email">
</div>
<div>
<label for="accounts_payable_phone">Accounts Payable Contact Phone: </label>
<input type="text" name="accounts_payable_phone" id="accounts_payable_phone">
</div>
<h2>Banker Information</h2>
<div>
<label for="bank_name">Bank Name: </label>
<input type="text" name="bank_name" id="bank_name">
</div>
<div>
<label for="bank_contact_name">Bank Contact Name: </label>
<input type="text" name="bank_contact_name" id="bank_contact_name">
</div>
<div>
<label for="bank_contact_email">Bank Contact Email: </label>
<input type="text" name="bank_contact_email" id="bank_contact_email">
</div>
<div class="vendor-section" style="display: none;">
<h2>Vendor Reference Information</h2>
<span class="">At least one vendor is required for Credit Terms.</span>
<h3>Vendor #1</h3>
<div>
<label for="vendor_name">Vendor Name: </label>
<input type="text" name="vendor_name_1" id="vendor_name_1">
</div>
<div>
<label for="vendor_contact_name_1">Vendor Contact Name: </label>
<input type="text" name="vendor_contact_name_1" id="vendor_contact_name_1">
</div>
<!--
<div class="select_vendor_type">
<label for="vendor_contact_type_1">Vendor Contact Type: </label>
<select name="vendor_contact_type_1" id="vendor_contact_type_1"><option selected="selected" value="Email">Email</option>
<option value="Fax">Fax</option></select>
</div> -->
<div>
<label for="vendor_contact_email_1">Vendor Contact Email: </label>
<input type="text" name="vendor_contact_email_1" id="vendor_contact_email_1">
</div>
<div>
<label for="vendor_contact_fax_1">Vendor Contact Fax: </label>
<input type="text" name="vendor_contact_fax_1" id="vendor_contact_fax_1">
</div>
<h3>Vendor #2</h3>
<div>
<label for="vendor_name">Vendor Name: </label>
<input type="text" name="vendor_name_2" id="vendor_name_2">
</div>
<div>
<label for="vendor_contact_name_2">Vendor Contact Name: </label>
<input type="text" name="vendor_contact_name_2" id="vendor_contact_name_2">
</div>
<!--
<div class="select_vendor_type">
<label for="vendor_contact_type_2">Vendor Contact Type: </label>
<select name="vendor_contact_type_2" id="vendor_contact_type_2"><option selected="selected" value="Email">Email</option>
<option value="Fax">Fax</option></select>
</div> -->
<div>
<label for="vendor_contact_email_2">Vendor Contact Email: </label>
<input type="text" name="vendor_contact_email_2" id="vendor_contact_email_2">
</div>
<div>
<label for="vendor_contact_fax_2">Vendor Contact Fax: </label>
<input type="text" name="vendor_contact_fax_2" id="vendor_contact_fax_2">
</div>
<h3>Vendor #3</h3>
<div>
<label for="vendor_name">Vendor Name: </label>
<input type="text" name="vendor_name_3" id="vendor_name_3">
</div>
<div>
<label for="vendor_contact_name_3">Vendor Contact Name: </label>
<input type="text" name="vendor_contact_name_3" id="vendor_contact_name_3">
</div>
<!--
<div class="select_vendor_type">
<label for="vendor_contact_type_3">Vendor Contact Type: </label>
<select name="vendor_contact_type_3" id="vendor_contact_type_3"><option selected="selected" value="Email">Email</option>
<option value="Fax">Fax</option></select>
</div> -->
<div>
<label for="vendor_contact_email_3">Vendor Contact Email: </label>
<input type="text" name="vendor_contact_email_3" id="vendor_contact_email_3">
</div>
<div>
<label for="vendor_contact_fax_3">Vendor Contact Fax: </label>
<input type="text" name="vendor_contact_fax_3" id="vendor_contact_fax_3">
</div>
<h3>Vendor #4</h3>
<div>
<label for="vendor_name">Vendor Name: </label>
<input type="text" name="vendor_name_4" id="vendor_name_4">
</div>
<div>
<label for="vendor_contact_name_4">Vendor Contact Name: </label>
<input type="text" name="vendor_contact_name_4" id="vendor_contact_name_4">
</div>
<!--
<div class="select_vendor_type">
<label for="vendor_contact_type_4">Vendor Contact Type: </label>
<select name="vendor_contact_type_4" id="vendor_contact_type_4"><option selected="selected" value="Email">Email</option>
<option value="Fax">Fax</option></select>
</div> -->
<div>
<label for="vendor_contact_email_4">Vendor Contact Email: </label>
<input type="text" name="vendor_contact_email_4" id="vendor_contact_email_4">
</div>
<div>
<label for="vendor_contact_fax_4">Vendor Contact Fax: </label>
<input type="text" name="vendor_contact_fax_4" id="vendor_contact_fax_4">
</div>
</div>
<h2>Questions</h2>
<p>Please enter any comments or questions in the box below (optional)</p>
<div class=" comments">
<label for="comments">Comments/Questions: </label>
<textarea name="comments" id="comments"></textarea>
</div>
<div class="disclaimer">
<h2>Standard Credit Terms: Net 30 Days (Early pay discounts are available)</h2>
<p> All statements made herein are true and accurate to the best of our knowledge. We authorize Welch Packaging (WP) to review the information contained on this application and authorize Bank & Trade References to release any requested
information for the purpose of granting credit. We authorize (WP) to make any and all inquiries necessary for action on this credit application. We additionally indemnify WP, and it's agents, from the liability resulting from their credit
survey. Should this account upon default be collected by or through a collection agency/attorney, we agree to pay collection/attorney fees in addition to the principal indebtedness including interest at the maximum rate allowed by the law with
intent calculated from the date of default. </p>
<p>
</p>
<div class="initial_box"> Initial Here:<input type="text" name="initial" id="initial">
<span class="error">You must enter your initials to submit.</span>
</div>
<div class="agree_box">
<input type="checkbox" name="agree" id="agree" value="1"><label for="agree">I agree to the Terms and Conditions stated above.</label>
<p></p>
<span class="error">You must agree to these terms to submit.</span>
</div>
</div>
<div class="trust-logo" style="margin-left: auto; margin-right: auto; text-align: center; ">
<script language="JavaScript" type="text/javascript">
TrustLogo("https://credit.welchpkg.com/assets/comodo_secure_seal_113x59_transp.png", "CL1", "none");
</script>
<a href="javascript:if(window.open('https://secure.trust-provider.com/ttb_searcher/trustlogo?v_querytype=W&v_shortname=CL1&v_search=https://welchpkg.dev.ibsinternet.com/&x=6&y=5','tl_wnd_credentials'+(new Date()).getTime(),'toolbar=0,scrollbars=1,location=1,status=1,menubar=1,resizable=1,width=374,height=660,left=60,top=120')){};tLlB(tLTB);" onmouseover="tLeB(event,'https://secure.trust-provider.com/ttb_searcher/trustlogo?v_querytype=C&v_shortname=CL1&v_search=https://welchpkg.dev.ibsinternet.com/&x=6&y=5','tl_popupCL1')" onmousemove="tLXB(event)" onmouseout="tLTC('tl_popupCL1')" ondragstart="return false;"><img src="https://credit.welchpkg.com/assets/comodo_secure_seal_113x59_transp.png" border="0" onmousedown="return tLKB(event,'https://secure.trust-provider.com/ttb_searcher/trustlogo?v_querytype=W&v_shortname=CL1&v_search=https://welchpkg.dev.ibsinternet.com/&x=6&y=5');" oncontextmenu="return tLLB(event);"></a><!---->
<div id="tl_popupCL1" name="tl_popupCL1" style="position:absolute;z-index:0;visibility: hidden;background-color: transparent;overflow:hidden;" onmouseover="tLoB('tl_popupCL1')" onmousemove="tLpC('tl_popupCL1')" onmouseout="tLpB('tl_popupCL1')">
</div>
</div>
<div class="actions">
<div class="button-wrapper"><input type="submit" name="commit" value="Submit" data-disable-with="Submit"></div>
<div class="button-wrapper"><input type="submit" name="draft" value="Save Draft" data-disable-with="Save Draft"></div>
</div>
</form>Text Content
WELCH PACKAGING CREDIT APPLICATION / CLIENT INFORMATION Continue on a previous draft? Click Here In an attempt to simplify and speed up your credit approval, we have developed this automatically generated credit process. By completing the information below, you will send credit information requests to your selected banker and vendors. They will be able to provide us relevant credit information and reply electronically so that we can establish your credit limit quickly and efficiently. Your Name: Your Email Address: Company Name: Company Address: City: State: Zip: Billing Address same as above: Billing Address: City: State: Zip: Company Phone: Company Fax (optional): Type of Business: S-Corp LLC Partnership Sole Proprietor C-Corp Federal ID Number: Estimated Annual Sales with Welch Packaging: Date Business Started: Welch Location: Select a Location Tax Exempt: Yes No Tax Exempt Certificate Upload: This application is for: Credit Terms Credit Card Terms Cash in Advance Credit Card Information: Please download this Credit Card Form if you choose credit card terms. Download Form Invoice Method: Email Fax Mail Invoice Email Address: Invoice Fax Number: ACCOUNTS PAYABLE INFORMATION Accounts Payable Contact Name: Accounts Payable Contact Email: Accounts Payable Contact Phone: BANKER INFORMATION Bank Name: Bank Contact Name: Bank Contact Email: VENDOR REFERENCE INFORMATION At least one vendor is required for Credit Terms. VENDOR #1 Vendor Name: Vendor Contact Name: Vendor Contact Email: Vendor Contact Fax: VENDOR #2 Vendor Name: Vendor Contact Name: Vendor Contact Email: Vendor Contact Fax: VENDOR #3 Vendor Name: Vendor Contact Name: Vendor Contact Email: Vendor Contact Fax: VENDOR #4 Vendor Name: Vendor Contact Name: Vendor Contact Email: Vendor Contact Fax: QUESTIONS Please enter any comments or questions in the box below (optional) Comments/Questions: STANDARD CREDIT TERMS: NET 30 DAYS (EARLY PAY DISCOUNTS ARE AVAILABLE) All statements made herein are true and accurate to the best of our knowledge. We authorize Welch Packaging (WP) to review the information contained on this application and authorize Bank & Trade References to release any requested information for the purpose of granting credit. We authorize (WP) to make any and all inquiries necessary for action on this credit application. We additionally indemnify WP, and it's agents, from the liability resulting from their credit survey. Should this account upon default be collected by or through a collection agency/attorney, we agree to pay collection/attorney fees in addition to the principal indebtedness including interest at the maximum rate allowed by the law with intent calculated from the date of default. Initial Here: You must enter your initials to submit. I agree to the Terms and Conditions stated above. You must agree to these terms to submit. Push "Submit" to send this form to Welch Packaging Credit Department and to generate credit information requests to your Banker and selected vendors listed above. Thanks for your help in streamlining the credit process. Welch Packaging-Delivering the Ultimate Corrugated Experience! Welch Packaging 1020 Herman Street Elkhart, IN 46516-9028 (574) 295-2460