1272 Alma Court San Jose, CA 95112-5940

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APPLICATION FOR CREDIT TERMS: NET 30 Accounts are only opened upon placement of a $500 order.

If your product total is less than $500 you may use our on-line order form. (Click Here)

     Contact Name:                                                  Date:
    Account Name:
Business Address:
                     City:State:Zip Code:
  Business Phone:Fax Number:
    Email Address:
 
Business Accounts
                         Type of Business:
                         Owner/Principal:
                                            Title:
  When was business established?
  Do you require PO#ís on all Yes
                           purchases? No
 
                                 D&B Number: D&B Rating:
 
   (A)    Bank Name:
                 Address:
                Phone #:
             Account #:
 
   (B)    Please list three (3) Credit References:
            1.    Name:
                Address:
                  Phone:Fax:
                Contact:
            2.    Name:
                Address:
                  Phone:Fax:
                Contact:
            3.    Name:
                Address:
                  Phone:Fax:
                Contact:
 
Authorized Signature:_____________________________________________ Date:
Please Complete Print and Fax to (408) 494-0804
          Phone: (408) 924-0800