Firm Name:__________________________________________________________
Billing Address:_____________________________ Ship To:__________________
City:_______________________ State:_______ Zip Code:___________________
Incorporated:__________ Partnership:__________ Individual:_______________
Type of Business:_____________________________________________________
How Long in Business?_______________________ This Location:____________
Principals:
Name:______________________________ Title:___________________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Name:______________________________ Title:___________________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Bank References:
Name:______________________________________________________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Contact Person:________________________ Title:_________________________
Trade References: (4 Required)
Name:_______________________________ Your Acct.#____________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Fax:_________________________ Contact Person:_________________________
Name:_______________________________ Your Acct.#____________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Fax:_________________________ Contact Person:_________________________
Name:_______________________________ Your Acct.#____________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Fax:_________________________ Contact Person:_________________________
Name:_______________________________ Your Acct.#____________________
Address:____________________________ City:___________________________
State:___________ Zip Code:________________ Phone:____________________
Fax:_________________________ Contact Person:_________________________
Resale? (If yes, attach resale card) Yes:______ No:______
How much are you requesting? $___________________
Bearings Supply Company, Inc. Terms are as Follows:
Net 30 days from invoice date. All past due accounts are subject to be placd on C.O.D. status. A 1.5% finance charge will be applied to all past due accounts. This is an anual percentage
rate of 18%. These finance charges are due and payable. By signing this credit appliction, you are agreeing to pay your account according to our terms stated above and any legal fees collecting the money.
I herby grant permission for Bearings Supply Company, Inc. to verify this information. Signature:_______________________________ Date:__________________ |