678-376-7794
$10 OFF your order of $100 or More
(Use Promo Code "10 OFF")
(Use Promo Code "10 OFF")
Credit Application
| SOURCETEL APPLICATION FOR CREDIT | |
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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 #: | _____________________________ |
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Bank Reference |
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Primary Bank: |
_______________________________________________________ |
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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: | _____________________________ |
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Please return by fax to (678) 376-4829, attention: Credit Department |
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