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Federal ID# (Social Security#). |
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Sales Tax Exempt# |
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Type of Business |
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Telephone#......... |
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Fax #........................ |
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Dun & Bradstreet#.... |
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Company Name........ |
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Email Address........... |
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Web Site Address..... |
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Contact Name........... |
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Business Type........... |
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Area You Cover........ |
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Years in Business...... |
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Approx. Yearly Sales |
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# of Employees.......... |
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Credit Required......... |
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Acct Payable Contact |
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Acct Pay Phone #..... |
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Acct Pay Fax #......... |
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Comments........... |
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Mailing Address |
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Billing Address |
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Shipping Address |
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Trade Reference 1 (no credit cards please) |
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Included Name, Phone #, and
Fax # |
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Trade Reference 2 (no credit cards please) |
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Included Name, Phone #, and
Fax # |
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Trade Reference 3 (no credit cards please) |
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Included Name, Phone #, and
Fax # |
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Bank Reference |
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Include Name, Address,
Telephone #, Fax #, Account Number, and Bank Officer |
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= required fields |
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I/We hereby authorize any and all references given by
applicant to answer and reveal any and all credit
information, history and details about my/our account to
Filter-Mart Corporation.
Applicant's clicking
on the apply button attests acceptance of agreement,
financial responsibility, the ability and willingness to pay
our invoices in accordance with the following terms and
conditions. Terms of payment are Net 30 from date of
invoice/shipment of product or service. Interest will be
charged at the rate of 1.5% per month on all delinquent
accounts. Applicant will be responsible for any attorney
fees, court costs and post judgment interest, if default
litigation occurs. This agreement shall be enforced in
accordance with the laws of the state of Tennessee.
The above
information is for the purpose of obtaining credit and is
warranted to be true. I/we hereby understand that the above
terms are subject to Filter-Mart Corporation approving your
application for credit. |
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