APPLICATION FOR CREDIT

Company Info

Company Name: *

Bill To Address: *

Delivery Address: *

City: *

State: *

Zip: *

Business Phone #: *

Business Fax #: *

Email: *

Preferred Username

Preferred Username field can contain only letters, numbers and @, +, ., -, _ characters

Accounts Payable

Person's Name: *

Phone #: *

Fax #: *

Email: *

Contact Preferences

How would you like to receive your invoices: *

How would you like to receive your statement: *

I would like to be set up as a cash on delivery (C.O.D.) account

Yes

Four Active Credit References (businesses that allow you to charge now)

Name:

Address:

City, State, Zip:

Phone #

Fax #

Four Active Credit References 2

Name:

Address:

City, State, Zip:

Phone #

Fax #

Four Active Credit References 3

Name:

Address:

City, State, Zip:

Phone #

Fax #

Four Active Credit References 4

Name:

Address:

City, State, Zip:

Phone #

Fax #

Our terms are 30 days net. Penalties of 1 ½% per month will be assessed if not paid within 30 days or unless bill is otherwise stipulated. There is a $20 charge for all returned checks. Accounts that are turned over to a collection agency will be charged a fee of $25.

If this is for resale, please send us a signed California Certificate of Resale with your Resale # .

Leave this field blank

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