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Credit Account Application Credit Account Application

NOTE: If you already have an account with us, please login at the login page.
Company Details * Required information
Company Name:  
Street Address:  *
City:  *
State/Province:  *
Post Code:  *
Country:  *
Tax ID:  *
Telephone Number:  *
Fax Number:  
Credit Amount Requested : $  *
Length of time in business:  *
Company Type:  *
Number of employees:  *
Credit References: Give complete Name, Address, Phone Number, and Fax Number
Reference:  * Address:  *
City:  * State:  *
Phone:  * Fax:  *
Accounts Payable Contact:
Gender:   Male    Female *
First Name:  *
Last Name:  *
E-Mail Address:  *
Telephone Number:  *
Account Password:
Password:  *
Password Confirmation:  *
TERMS: NET 15

A FINANCE CHARGE of 2% per month (APR 24%) will be added to all outstanding amounts after 30 days from date of invoice.

If this account is refereed to a third party collection agency all associated collection cost will be paid by you, the customer.

Authorization is granted to make credit inquires with the references listed above. BY CLICKING THE SUBMIT BUTTON BELOW I HAVE READ THE ABOVE AND AGREE TO COMPLY WITH THE TERMS OF PAYMENT AND OTHER STATED CONDITIONS.

 
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