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Credit Application
Application for Credit Form
 

This form is intended only for Scale Dealers, OEM and Scales Service Companies.
End users will be discarded or re-directed to a distributor in their area.
 
* Required information
 
Company Information*
Company Name:
Contact Name:
Street Address:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:
E-Mail:
Years in Business:

Business Status*

Type of Business*
Corporation
Manufacturer
Manufacturer
Dealer
Individual
Service
Name of Officers, Owner or Partners*
President:
Vice President:
Secretary:
Treasurer:
Owners:
Partner:
Bank Reference*
Bank Name:
Street Address:
City:
State/Province:
Zip Code:
Country:
Bank Phone:
Bank Fax:
Account Number:
Business References*
  
 At least one reference must be given
 
Reference 1*         Reference 2   Reference 3
Full Name:
Street Address:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:
 
 
Full Name:
Street Address:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:
 
 
Full Name:
Street Address:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:
 
Tax Exempt Number:
 
*Note: Terms are Net 30 days, 1.5% per month finance Charge on unpaid balance after 30 days. 18% annual rate. If account is sent to a collection agency, a 25% service charge for collection will be added.
     
I Agree (type your name)
Title:
Date:
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enter in the letters in the box.