Credit Application

Apply to Finance Process Control and Temperature Equipment

FIRM NAME*
BILL-TO-ADDRESS*
FIRM TELEPHONE NO.*
FAX NO.*
ACCOUNTS PAYABLE
SUPERVISOR*
TELEPHONE*
E-MAIL*
ACCOUNT PAYABLE CONACT*
TELEPHONE*
DUN AND BRADSTREET NO.*
TYPE OF BUSINESS:*
- Corporation
- Partnership
- Sole Proprietorship
YEARS IN BUSINESS*
TRADE REFERENCES:
NAME :
ADDRESS
TELEPHONE #
FAX #
E-MAIL ADDRESS:*
NAME :
ADDRESS
TELEPHONE #
FAX #
E-MAIL ADDRESS:*
NAME :
ADDRESS
TELEPHONE #
FAX #
E-MAIL ADDRESS:*
PLEASE FAX SALES TAX STATUS OF YOUR PURCAHSE
CREDIT LIMIT YOU ARE REQUESTING
NOTE: Finance charges of 1 ½% monthly charged to late payments. All expenses necessary to collect past due accounts, including attorney fees, permitted by law, will be payable in full. PERSONAL GUARANTEE OF PAYMENT I personally guarantee payment in full to the above account and agree to the terms of sale.
PRINCIPAL
PRINT NAME
TITLE
DATE
MM slash DD slash YYYY