Company Name
Address
P.O. Box
City
State Zip code
Phone Fax
E-mail
Principal/President
Vice President
No. of Yrs. in Business CORP
Resale No.   SOLE PROPRIETOR
Are P.O.'s Required? Duns #
Have you every declared bankruptcy?  S.S. #
Date of Discharge Fed ID #
Corporation Partnership Proprietorship
.
If In Business Less Than 3 years, or Business Is a proprietorship or Partnership, The Following Information MUST BE COMPLETED.
.
Owner Name
Address
City, State, Zip
Phone
Email
.e
Owner Name
Address
City, State, Zip
Phone
Email
.
PRINCIPAL BANK:
Name
Branch
Account No.
Contact
Address
City, State, Zip
Phone
Email
Fax
CREDIT REFERENCES
Name
Address
City, State, Zip
Phone
Email
Fax
Contact
.
Name
Address
City, State, Zip
Phone
Email
Fax
Contact
.
Name
Address
City, State, Zip
Phone
Email
Fax
Contact
.
Credit Line Requested
.
Who is authorized to purchase goods?
.
Name Title
Name Title
Name Title
.
In consideration of the extension of credit by Material Handling Supply, Inc., We agree to the following terms and conditions:
.
(1) Payment terms: Net 10 days from date of invoice on all parts and service invoices: Equipment sales net due on delivery.
(2) Applicant further agrees to pay all collections cost, including attorney's fee and court cost in case it is necessary to take legal action to collect past due accounts.
(3) Material Handling Supply . Inc. reserves the right to assess a finance charge 1.5% monthly. If outstanding balance becomes delinquent.
(4) Authorization to release banking, trade references, and credit information to Material Handling Supply, Inc., and Nissan Motor Acceptance Corp.
(5)The information provide above is truthful to the best of his/her knowledge

__________________________________
Applicant ensures that 
.
We Agree
By Title:
Date
    

 

 

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