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Credit Application
Company Name DBA
Contact Name Title
Street Address City State Zip Code
Phone Fax
Year Incorporated Yrs. at Present
Location
Proprietor or Partner's Name
President Controller
Type of business

BANK INFORMATION

Bank on which checks are drawn CA Resale Number
Street Address
City State Zip Code
Contact Person Phone
Account #

TRADE REFERENCES

Company Name Address
City State Zip Code
Contact Person Telephone
Company Name Address
City State Zip Code
Contact Person Telephone
Company Name Address
City State Zip Code
Contact Person Telephone
  • Please note that this form is for US customers, who are resellers, only.
  • This form must be filled out completely to receive COD company check. To be considered for net terms, please attach a current financial statement.
  • Also, please do not use Merisel, Marshall, Ingram Micro, Synnex IT, Tech Data or Wyse Technology as references. They do not provide any information.
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