Credit Application

Name of Firm or Individual:*
Telephone Number:*
Fax Number:
Years in Business:*
Address*
Dirección Dirección 2 Ciudad Estado / Provincia / Región ZIP / Código Postal País
Type of Business:*
Credit Limit Requested:*
THE FOLLOWING INFORMATION MUST BE PROVIDED FOR CONSIDERATION OF EXTENDED CREDIT. ALL INFORMATION WILL BE HELD INT HE STRICTEST OF CONFIDENCE AND USED ONLY TO ESTABLISH AN OPEN ACCOUNT.

*Please attach a copy of your completed tax-exempt certificate if applicable.
File
Name of President or Owner:*
Nombre Apellidos
Name of Controller:*
Nombre Apellidos
Accounts Payable Contact:*
Nombre Apellidos
TRADE REFERENCES
Reference #1:
Business Name:*
Telephone Number:*
Fax Number:*
Address*
Ciudad Estado / Provincia / Región
Reference #2:
Business Name:*
Telephone Number:*
Fax Number:*
Address*
Ciudad Estado / Provincia / Región
Reference #3:
Business Name:*
Telephone Number:*
Fax Number:*
Address*
Ciudad Estado / Provincia / Región
BANK REFERENCES
Bank Name:*
Telephone Number:*
Fax Number:*
Address*
Ciudad Estado / Provincia / Región
Account Officer Name:*
Nombre Apellidos
Account Number:*
We certify that all information supplied is correct. We fully understand your credit terms of N/30 and agree to payment within these terms in consideration of extended credt. We also understand that for credit limits in excess of $50,000 a copy of our most current financial statement is required.
Date:*
Formato de fecha:MM barra DD barra AAAA
Signed:*
Title:*

TRADE REFERENCES