Cooney Technologies - Credit Application

Credit Application

New Customer Terms Application
- Legal Name
- Business Trade Name
- Tax ID
- DUNS
- Are you Tax Exempt?
  
  YesNo
- If you are tax exempt, please attach your tax-exempt certificate.
  
  Cancelof
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Fax Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Shipping Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Ownership Type
  
  Sole ProprietorshipLimited PartnershipGeneral PartnershipCorporation
- Owners name
- In business since
- Type of business
- Accounts Payable Contact
- Accounts Payable Contact Name
- Phone
  Format: (000) 000-0000.
- Email
  example@example.com
- Fax
- Please send invoices via
  
  EmailUS MailFax
- Email to Send Invoices To
  example@example.com
- US Mail Address to Send Invoices To
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Fax to Send Invoices To
  Please enter a valid phone number.Format: (000) 000-0000.
- Account Type
  
  CheckingSavings
- Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Account number
- Contact person
- Phone
  Format: (000) 000-0000.
- Reference 1
- Name
- Contact
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Reference 2
- Name
- Contact
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Reference 3
- Name
- Contact
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Reference 4
- Name
- Contact
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Cooney Coil payment terms is Net 30 days. Any customer whose account is more than 30 days past due will be placed on credit hold until the account is current. By signing this credit application, the applicant certifies that the information contained herein is complete & accurate, and the person executing this agreement has authority to bind the customer and is authorized by the customer to enter into/agree to the terms & conditions located @ https://www.cooneytechnologies.com/support/
- Signature
- Print Name
- Title
- Send completed credit application to bezzy@cooneycoil.com
- Should be Empty:

Credit Application

Accounts Payable Contact

Reference 1

Reference 2

Reference 3

Reference 4