PHASE-A-MATIC, INC.
CREDIT APPLICATION Firm Name__________________________________Phone_______________Fax_______________ Billing Address___________________________City____________________State_____Zip_______ Delivery Address_________________________City____________________State_____Zip_______ Type Of Business_____________________________Resale Number_________________________ Name Of Parent Company If Subsidiary________________________________________________ President, Proprietor Or Partner's Name_______________________________________________ Home Address & Phone______________________________________________________________ Accounts Payables Supervisor__________________________________Phone________________ At Present Location Since_______________________________Year Established______________ Is Business Incorporated?______ If So, Under
Laws Of What State?_______________________ TRADE REFERENCES: - Give Only Names Of Those You Buy From On Open Account Name______________________________________Contact_________________________________ Address_______________________________City_______________________State_____Zip______ Account Number__________________________Phone_________________Fax________________ Name______________________________________Contact_________________________________ Address_______________________________City_______________________State_____Zip______ Account Number__________________________Phone_________________Fax________________ Name______________________________________Contact_________________________________ Address_______________________________City_______________________State_____Zip______ Account Number__________________________Phone_________________Fax________________ Name______________________________________Contact_________________________________ Address_______________________________City_______________________State_____Zip______ Account Number__________________________Phone_________________Fax________________ Bank____________________________________Account Number____________________________ Address____________________________City_______________________State______Zip_________ Amount Of Credit Applied For________________________ Our Terms Are NET-30. Payment Is Due Not Later Than 30 Days After Invoice Date. Name_____________________________________Title_____________________________________ Signature__________________________________Date____________________________________ FOR OFFICE USE ONLY: Credit Approved By: Limit: Date: |