Credit Application Form
Please return this application to: accounting@temperaturecontrolsystems.com
*
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Month
/
Day
Year
Today's Date
Application must be completed and signed to be processed for credit account. You may submit a list of credit references in place of completing the credit reference section. Incomplete applications are subject to refusal of credit.
Business Information
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Company Name
DBA (if applicable)
Address Information
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Information
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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example@example.com
Phone Number
*
Please enter a valid phone number.
Contact Name
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Accounting
Purchasing
Email For Accounts Payable
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example@example.com
Email For Purchasing
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example@example.com
Are purchase order numbers required?
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Yes
No
Exemption Tax Information
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Taxable
Non taxable -- Attach exemption form
Our terms are net 30 days from the invoice date remit to: Post Office Box 550249 Dallas, TX 75355-0249
Business Established
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Month
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Day
Year
Date
Dun & Bradstreet rated?
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Yes
No
Dun & Bradstreet #
*
Federal Tax Id #
*
Exemption tax information
*
Corporation
Limited partnership
Joint venture
Management
Sole proprietorship/Individual
If you are the sole proprietorship/individual or agent for/management, you must completed the following for the application to be processed.
Owner Information
*
First Name
Last Name
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security #
Phone #
*
Please enter a valid phone number.
Applicant's Signature
*
Owner or autherized agent
Type of Business
Exemption tax information
*
Manufacturing
Government
Service//HVAC
Medical
Management
Other
Credit References
Contact Information
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Name
Address
Phone number
Email address
1
2
3
Officers of the company: (must be completed)
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First & Last Name
Title
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First & Last Name
Title
Credit Amount Requested
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Acknowledgement & Consent
We the undersigned, and any or all their parties pertaining to this application for credit agree that at anytime should this account become in arrears, lading to the outside collection of this account by sources other than our own, that all fees accrued pertaining to the collection of said account will be the responsibility of said applicant and not those of Temperature Control Systems.
Today's Date
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Month
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Day
Year
Date
Co-Applicant's Signature
*
We the undersigned, certify that we are authorized to seek credit from Temperature Control Systems for the company or individual names on this application to be in form of a charge account and that we understand and will comply with the terms and credit limits of the account as set forth.
Today's Date
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Month
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Day
Year
Date
Co-Applicant's Signature
*
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