Credit Application

 

Company Name:

Registered As:

 

 

Street Address:

City:

 

 

Province/State:

Postal/Zip Code:

Country:

 

 

 

Phone:

Fax:

Type of Business:

 

 

 

Proprietorship: Partnership :     

Corporation since:

Accounts Payable Contact:

Accounts Payable Phone #:

 

 


Amount of Credit:

Fed. ID #:

D&B#:

 

 

 

 

Bank (Branch & Address)

Account #:

 

 

Bank Contact:

Phone:

 

 

 

Trade References

 

1) Name:

Street Address:

 

 

Zip/Postal Code:

Phone:

State:

Fax:

 

2) Name:

Street Address:

 

 

Zip/Postal Code:

Phone:

State:

Fax:

 

3) Name:

Street Address:

 

 

Zip/Postal Code:

Phone:

State:

Fax:

 

I understand that Bestwork Industries' terms are NET 30 DAYS of date of invoice, unless otherwise stipulated in writing, and that a service charge of two percent (2%) per month will be paid by the customer on all amounts over these terms. I hereby certify that the information provided is correct to the best of my knowledge.

I hereby authorize Bestwork Industries to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement.

Signature 

 

Name of Principal Officer:

Title:

 

 

Print this completed form, sign, and fax to (856) 751-2765

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