Credit Application for U.S. Businesses

(for repeat customers who wish to sent up an account with Instrument Sales--all first orders from new customers must be prepaid with a credit card, cashiers check or cleared company check.)

Business Name:
Phone:
FAX:
Address:
City:	State: ZIP:
Years in Bus:		Net Worth:
Annual Sales:		No. of Employees:
Type of Business:
Federal ID #		Dunn & Bradstreet #
Credit Line Requested:		If over $10,000, please provide Financial Statements
	In order to serve you better please indicate whether you are interested in purchasing items: Yes No If Tax Exempt, please provide Tax Exempt Certificate

Business Owners or Officers (3)

Name:
Title:
Home Phone:
SSN#
Address:
City:	State: ZIP:

Name:
Title:
Home Phone:
SSN#
Address:
City:	State: ZIP:

Name:
Title:
Home Phone:
SSN#
Address:
City:	State: ZIP:

Bank References (where applicable)

Savings Account #:
Checking Account #:
Loan Account #:
Bank Name:
Contact:
Phone #:
Address:
City:	State: ZIP:

Trade References (3)

Business Name:
Contact:
Phone:
Email:
Address:
City:	State: ZIP:

Business Name:
Contact:
Phone:
Email:
Address:
City:	State: ZIP:

Business Name:
Contact:
Phone:
Email:
Address:
City:	State: ZIP:

Organization Contacts

Field Supervisor:
Financial Manager:
Technical Manager:
Additional Contact:
Has applicant ever had a previous account with Instrument Sales? Yes No
Is this a headquarters with branch locations? Yes No If so please list nearest branch.
Phone:
Address:
City:	State: ZIP:

Payment Terms

Purchaser agrees to make payments in full on or before the due date shown on the Invoice or statement or else a delinquency charge of 1.5% per month will be imposed on all past due balances. The information on this application is for the purpose of obtaining credit, and Applicant acknowledges that Instrument Sales will rely on it for granting credit. Applicant certifies that such information is true, correct and complete. Applicant authorized Instrument Sales to investigate Applicants credit history and to furnish information on Applicant's credit history and payment performance to credit agencies or other businesses.

Authorized Signer, Applicant, accepts and agrees to the terms and conditions on this application and acknowledges that the above names financial institutions to furnish credit information to Instrument Sales.

Date:
Applicant's Name:
Title:
Email:

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Prices and specifications are subject to change without notice.