To
apply for credit, please print the form below and fax it back to
215-441-0423 or call 215-441-5305 for assistance.
Download this document, click
here.
APPLICATION FOR CREDIT
Date: ___/___/___
Firm Name: __________________________________________________________
Proprietor or Partners Name:
____________________________________________
Address: ___________________________________________________________
___________________________________________________________
Phone Number: ( ) ______________ Fax Number: ( ) ________________
TRADE REFERENCES - Open Account Only
Name Address Telephone #
1.__________________________________________________________________
2.__________________________________________________________________
3.__________________________________________________________________
BANK REFERENCES
Name Address Telephone #
1.__________________________________________________________________
2.__________________________________________________________________
Dun & Bradstreet Number ______________________
I understand that Two Technologies terms are 2% 10 days Net 30 days.
Signature ___________________________________________________________
Title _______________________________________________________________
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