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	Country

Contact E-mail:
Phone Number: *

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

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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	Country

(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	Country

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	Country

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	Country

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	Country

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

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Position/Title:
Email
example@example.com
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