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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