Credit Application for Setting Up an Open Account

If you are exempt from sales and use taxes you must also complete the
sales and use tax exemption certificate.

In order to open an account for your company this application will need to be filled out. Pre-printed applications are acceptable, however please make sure that your form answers all the items on our application. Please include fax numbers for your references to expedite processing.

Credit application in .doc format
 
Name    
Title   
Company 
Address 
        
City             State 
Zip        Country 
Phone          Fax
E-mail  

1) Type of Organization:
  
2) Country/State of Incorporation
 
3) Federal I.D.# 

4) Date Business Started 
5) Type of Business:   

6) Annual Sales Volume $
7) Accounts Payable Contact 
8) Second A/P Contact 
9) List all Officers or Partners
 


10) Bank Name 
      Address 
         City State 
     Zip code 
      Country 
       Phone# 
     Account# 
11.) List Four Trade References -
 1) Name 

 Address 
 City 
   State/Province 
  Zip/Postal code 
 Phone # 
 Fax #  (very important)
 Billing contact 

 2) Name 
 Address 
 City 
   State/Province 
  Zip/Postal code 
 Phone # 

 Fax #  (very important)
 Billing contact 
 3) Name 
 Address 
 City 
   State/Province 

  Zip/Postal code 
 Phone # 
 Fax #  (very important)
 Billing contact 
 4) Name 
 Address 

 City 
   State/Province 
  Zip/Postal code 
 Phone # 
 Fax #  (very important)
 Billing contact 

12) Amount of credit requested: $
By sending this form I certify that all the information on this form is correct and we fully understand your credit terms are net 30 days. Past due accounts will be charged 1.5% per month (18% annual rate) on the past due balance. Shipments will not be made to accounts over 45 days. Orders will be placed on hold at 60 days and credit will be terminated at 75 days. We further agree to be liable for all legal fees on invoices referred to a collection agency or attorney.