|
|
| Credit Application Form IN THE EVENT THAT YOUR COMPANY HAS A CREDIT REFERENCE FORM PLEASE INCLUDE AND FAX WITH SIGNATURE AT THE BOTTOM OF THIS FORM TO 702-294-5133 JUNE COMPANY CREDIT APPLICATION FOR NET 30 ACCOUNT
COMPANY_________________________________________________________________
FEDERAL ID #______________________________________
BILLING ADDRESS_____________________________________________________ CITY____________________________ STATE_________________ ZIP___________ PHONE (_____)_____________________ FAX_(_____)_________________________ YEAR ESTABLISHED ____________________________________ D&B #______________________ TYPE OF ENTITY: CORPORATION _____ PARTNERSHIP_____ SOLE PROPRIETOR ________ TAX FILING STATUS: EXEMPT _______(PLEASE PROVIDE COPY OF TAX EXEMPTION FORM) TAXABLE __________
A/P CONTACT NAME ____________________________ A/P PHONE #_______________________EXT_________
BANK REFERENCE NAME____________ ____________________________ CONTACT NAME ______________________________________ PHONE # (_____)_______________________FAX (____)_________________________ ACCOUNT # ____________________________
TRADE REFERENCES: COMPANY ____________________________ CONTACT___________________________ PHONE (_____)________________________ FAX(____)____________________________ ACCOUNT.# ____________________________ COMPANY ____________________________ CONTACT___________________________ PHONE (_____)________________________ FAX(____)____________________________ ACCOUNT.# ____________________________ COMPANY ____________________________ CONTACT___________________________ PHONE (_____)________________________ FAX(____)____________________________ ACCOUNT.# ____________________________
I, _________________________ the undersigned, being a duly authorized representative of _______________________do hereby apply for net 30 day credit from June Company. I/We agree to honor the payment terms of net 30 days from invoice date. I also understand if invoices are not paid within the net 30 days from the invoice date, I/we also agree, to pay a finance charge of 2% monthly on the invoice balance and all collection charges, attorney’s fees and court costs where applicable.
SIGNATURE____________________________TITLE__________________DATE_________ SIGNATURE____________________________TITLE__________________DATE_________ |
