FILL OUT THE APPLICATION ATTACHED BELOW, AND FAX OR

E-MAIL TO US TO OPEN CREDIT WITH OUR COMPANY.

CREDIT APPLICATION

Fill this form out, and we will respond to you as soon as. Thank you for being interested in our services.

First Name
DBA:
In Business Since:
Billing Address:
Shipping Address:
Phone:
Fax:
Business Type Corporation:
Type of Business:
Do You Require a Purchase Order?:
Contact for Invoice Payments
Name:
Phone:
Fax:
E-Mail:
Title:
Credit References	Please provide fax numbers, to make the process faster. Thank you.
Reference #1:
Phone:
Fax:
Address:
Reference #2:
Phone:
Fax:
Address:
Reference #3:
Phone:
Fax:
Address:
CREDIT TERMS AND CONDITIONS	OUR CREDIT TERMS ARE NET 30 FROM DATE OF INVOICE, CUSTOMER AFREES TO REMIT PAYMENTS FOR MERCHANDISE IN ACCORDANCE WITH A-EAGLE CIRCUIT BREAKERS TERMS OF SALE AT THE ABOVE ADDRESS. THE ABOVE INFORMATION IS FOR THE PURPOSE OF OBTAINING CREDIT AND IS WARRANTED TO BE TRUE. I/WE HERBY AUTHORIZE A-EAGLE CIRCUIT BREAKERS COMPANY TO INVESTIGATE THE REFERENCES LISTED PERTAINING TO MY/OUR CREDIT FINANCIAL RESPONSIBILITY.
Name of Applicant:
Date:
Title: