To request credit from Bortech Corporation, Inc. Please fill out the form below. Processing of a credit application takes 48 hours. You will receive an email from our finance department notifying you of your approval. You may also download a PDF version of the credit application by clicking here. Note: * Denotes fields that are required.

*Company Name:
*Contact:
* Address:
* City:
* State:
* Zip:
* Phone:
* Fax:
* email:
* Years In Business:
References
* Business Name:
* Contact:
* Phone:
* Business Name:
* Contact:
* Phone:
Bank References
* Bank Name:
* Contact:
* Phone: