17031 Daimler Street, Irvine, CA 92614-5507
CREDIT
APPLICATION
Company
Name (Complete)
:_________________________________ Date
: ___________
Address
:___________________________________ City__________________
State:___________
Zip Code _______
Phone: (
)____ -______
Fax: (
)____ -_______
Length
of time in Business: _______________
Is
your Business Proprietorship
___ Partnership___ Corporation_____
Year
Incorporated: ______ State
Incorporated: _____ Credit Line
Request : $___________
Purchase
Order # Required YES [ ]
NO [ ]
Owner /Or Officer Information
1-Name___________________________
Address____________________________
Title___________________
City______________ State_______
Zip code_____
Phone:
(___)____-______
Social Security No.____-___ -_______
2-Name____________________
Address_______________________
Title___________________
City______________ State_______
Zip code_____
Phone:
(___)____-______
Social Security No.____-___ -_______
Bank's
Name:_________________ Account
#:___________________ Brunch#_______
Bank's
Officer::_________________ Title:_____________
Phone:_( )____-______
Address
:____________________ CITY:______________ State:_____Zip Code____
Bank's
Name:_________________ Account
#:___________________ Brunch#_______
Trade References
1.___________________ ____________________________________
Company Name Address
_______________________ _______________________________________
Contact Person City State Zip Code
______________________ __________________________ $__________
Phone # Account # Credit
Accounts Payable Agent ___________________ phone# ( ) _____________ Ext.#
2.___________________ ____________________________________
Company Name Address
_______________________ _______________________________________
Contact Person City State Zip Code
______________________ __________________________ $__________
Phone # Account # Credit
Accounts Payable Agent ___________________ phone# ( ) _____________ Ext.#
3.___________________ ____________________________________
Company Name Address
_______________________ _______________________________________
Contact Person City State Zip Code
______________________ __________________________ $__________
Phone # Account # Credit
Accounts Payable Agent ___________________ phone# ( ) _____________ Ext.#
All the information will be held in the strictest confidence , Purchaser recognizes top the term and conditions. it is further agreed by Purchaser, that if open account credit is extended, IDS Corp. is authorized to create security interest in it's inventory and proceed thereof.
Purchaser also understands and agrees that it will be responsible for payment of finance charge, attorney fees and court costs, if warranted.
The above information is given to IDS Corp. for obtaining credit is warranted to be true, I/We hereby authorize IDS corp. to investigate the listed pertaining to my/our credit and financial responsibility.
Firm Name: ____________________ By (Authorized Signature) ____________________ Name (TYPED) ____________________ Title _
Office Use Only
Credit Line assigned________________ Date approved ___________________By ____________ Initial Order ____________________
Terms_____________ NET 15days [ ] 25days [ ] 30 days [ ]