APPLICATION FOR CREDIT
* Please print
and fax
FIRM NAME:_________________________________________________DATE:____________________________
___CORPORATION ___PARTNERSHIP ___PROPRIETORSHIP
Description of business:____________________________________________________________________________
Address:_____________________________________________________City:_______________________________
State:__________Zip Code:_______________ Phone:________________________Fax:________________________
OFFICERS
President:_____________________________________Vice President:_____________________________________
Secretary:______________________________________Treasurer:________________________________________
Direct all accounting matters to:__________________________________Title:______________________________
REFERENCES:(List
major suppliers and amount owed or attach a separate credit reference
sheet)
Name: |
Address: |
Phone: |
Current Balance: |
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Bank Name and Official:____________________________________Phone:___________________________________
Bank Address:___________________________________Account No.:____________________________________
Terms: 2%-10Days, Net 30
In consideration of the granting and extension
of credit by Seller to the undersigned, it is hereby agreed that
the undersigned will promptly pay all sums when due. In the event
of non-payment, the undersigned does hereby agree to pay in addition
to the principal amounts due, all collection charges incurred
by Seller. The undersigned further agrees to pay interest at
the rate of 1 1/2% per month (18% per annum) commencing the day
following the due date .
Signed:____________________________
__________________________________________COMPANY
OFFICER________________________________
Print or Type Name
Pacific Design
Specialists, Inc.
San Diego, California
858/450-1672 | Fax: 858/450-0414
Email: sales@pacdes.com
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