Pacific Design Specialist, Inc. - Serving the Electronics Industry since 1993

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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:
     
       
       

 

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.
5230 Carroll Canyon Road, Suite 102
San Diego, California 92121
858/450-1672 | Fax: 858/450-0414
Email:
sales@pacdes.com
     
printedcircuit005 Credit Application