SOURCETEL APPLICATION FOR CREDIT | |
Company Info |
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Business Name: |
_______________________________________________________ |
Bill To Address: | _______________________________________________________ |
City: | _______________________________________________________ |
State: | _____________________________ |
Zip: | ______________ |
Country: | _____________________________ |
Phone Number: | _____________________________ |
FAX: | _____________________________ |
President or CEO: | _______________________________________________________ |
Credit Line Desired Per Month (USD) $: | _____________________________ |
Dun and Bradstreet #: | _____________________________ |
Bank Reference |
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Primary Bank: |
_______________________________________________________ |
Account Number: |
_______________________________________________________ |
Address: | _______________________________________________________ |
Phone: | _____________________________ |
FAX: | _____________________________ |
Trade References (provide 2)
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Company Name (1): | _______________________________________________________ |
Address: | _______________________________________________________ |
Phone: | _____________________________ |
FAX: | _____________________________ |
Account #: | _____________________________ |
Company Name (2): | _______________________________________________________ |
Address: | _______________________________________________________ |
Phone: | _____________________________ |
FAX: | _____________________________ |
Account #: | _____________________________ |
Tax exempt? (Please FAX tax exemption certificate with application) I authorize the release of any and all Credit / Banking information as required by and to Sourcetel Supply, LLC. By signing this document my organization accepts the Terms and Conditions for Orders from Sourcetel Supply, LLC.
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Signature: | _______________________________________________________ |
Title: | _____________________________ |
Date: | _____________________________ |
Please return by fax to (678) 376-4829, attention: Credit Department |
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