1272 Alma Court San Jose, CA 95112-5940
____________________________________________________________________________________________________________
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#’s 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 | ||