Credit Application

CREDIT APPLICATION

BFO BuyFittingsOnline.com
A Division of QMC Technologies, Inc
4388 Broadway • Depew • New York 14043
bfo@qmctechnologies.com • 1-800-569-0810
Company Name: *
Parent Company Name (If Different):
Billing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Shipping Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact E-mail:
Phone Number: *

Area Code Phone Number
Business Type: *
Years in Business: *
DUNS & BRADSTREET Number:
Requested Credit Limit Amount $: *
Tax Exempt
Tax Exempt: *
Upload Tax Exempt Certificate:

Browse Files

Cancel of
Bank References
(1) Bank Name: *
(1) Bank Phone Number: *

Area Code Phone Number
(1) Bank Account #: *
(1) Bank Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
(2) Bank Name:
(2) Bank Phone Number:

Area Code Phone Number
(2) Bank Account #:
(2) Bank Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Trade References
(1) Reference Name: *
(1) Reference Phone Number: *

Area Code Phone Number
(1) Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email: *
example@example.com
(2) Reference Name: *
(2) Reference Phone Number: *

Area Code Phone Number
(2) Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email: *
example@example.com
(3) Reference Name: *
(3) Reference Phone Number: *

Area Code Phone Number
(3) Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email: *
example@example.com
I certify that the above-provided information is true to the best of my knowledge. I understand that providing false documentation including tax exemption documents or failure to provide accurate and legitimate information, may result in loss or termination of established Net 30/credit terms at the discretion of BuyFittingsOnline.com & QMC Technologies, Inc.
Authorized Signature:
Date

Month Day Year
Date
Position/Title:
Email
example@example.com
Should be Empty:

Tax Exempt

Bank References

Trade References