Completely fill out the credit application form below and submit it for consideration.

 

Company Name:

Legal Name:
(if different)

List Names and Titles of Corporate Officers, Partners or Sole Proprietor:

#1:

#2:

#3:

#4:

#5:

BILLING Address:

City:

State or Province:

Zip  or Postal code:

Country:

SHIPPING Address:
(if different)

City:

State or Province:

Zip  or Postal code:

Country:

Phone:

Fax:

Email:

Type of Business:

Corporation

Partnership

Sole Partnership

Government Agency

 

Business Activities:

Access Control

CCTV

Other

 

Primary Markets:

Commercial

Gaming

Medical

Other

BACKGROUND

Years in Busines:

# of Employees:

Years at Present Location:

Annual Sales: (previous fiscal year)

Credit Line Requested:

IDENTIFICATION NUMBERS

Taxpayer Id #:

Sales Tax Exemption/
Resale #:

DUNS #:

BANK REFERENCES 

Bank Name:

Address:

Phone:

Contact/Account #:

Bank Name:

Address:

Phone:

Contact/Account #:

TRADE REFERENCES (list at least 3) 

Name:

Address:

Phone:

Contact:

Account #:

Name:

Address:

Phone:

Contact:

Account #:

Name:

Address:

Phone:

Contact:

Account #:

Name:

Address:

Phone:

Contact:

Account #:


Preferred Payment Method:


Visa - Account information will be taken 
     by phone and kept on file.  With each 
     order, product will be shipped upon 
     visa approval.
Net 30 days - Customer will be faxed a
     credit application to complete and return
     for approval.
Electronic Bank Transfer 
     


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