PHASE-A-MATIC, INC.

CREDIT APPLICATION

Firm Name__________________________________Phone_______________Fax_______________

Billing Address___________________________City____________________State_____Zip_______

Delivery Address_________________________City____________________State_____Zip_______

E-mail Address______________________________________________________________________

Type Of Business_____________________________Resale Number_________________________

Name Of Parent Company If Subsidiary________________________________________________

President, Proprietor Or Partner's Name_______________________________________________

Home Address & Phone______________________________________________________________

Accounts Payables Supervisor__________________________________Phone________________

At Present Location Since_______________________________Year Established______________

Is Business Incorporated?______  If So, Under Laws Of What State?_______________________
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TRADE REFERENCES: - Give Only Names Of Those You Buy From On Open Account

Name______________________________________Contact_________________________________

Address_______________________________City_______________________State_____Zip______

Account Number__________________________Phone_________________Fax________________
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Name______________________________________Contact_________________________________

Address_______________________________City_______________________State_____Zip______

Account Number__________________________Phone_________________Fax________________
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Name______________________________________Contact_________________________________

Address_______________________________City_______________________State_____Zip______

Account Number__________________________Phone_________________Fax________________
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Name______________________________________Contact_________________________________

Address_______________________________City_______________________State_____Zip______

Account Number__________________________Phone_________________Fax________________
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Bank____________________________________Account Number____________________________

Address____________________________City_______________________State______Zip_________
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Amount Of Credit Applied For________________________

Our Terms Are NET-30. Payment Is Due Not Later Than 30 Days After Invoice Date.

Name_____________________________________Title_____________________________________

Signature__________________________________Date____________________________________

FOR OFFICE USE ONLY:

Credit Approved By:                                      Limit:                              Date:

Print this page and fax the completed form to Phase-A-Matic at 1-661-947-8764, or mail to us at:
Phase-A-Matic, Inc., 39360 3rd St. E., Ste. 301, Palmdale, Ca. 93550-3255

 

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