Account Registration
Company Name
Contact
Mailing Address
City
State
Zip
Shipping Address
( if different)
City
State
Zip
Phone
Fax
E-Mail
Contact person for Accounts Payable
Hours for AP
Phone for AP
Web Site
Years in Business
Type of Business
D&B Listing
Credit Limit Requested
Bank Ref with Contace & Phone #
Credit Ref 1
Credit Ref 2
Credit Ref 3
Pmt Terms Requested:
Credit Card
Net 30*
Other
C.O.D.
Pre-Pay
If Other, please explain
Any other information you whish to offer:
* Net 30 based on credit approval