Brochure

packardonline.com
|
800.334.1769
449
BUSINESS CONTACT INFORMATION
Contact Name: Title:
Company Name:
Buying Group:
Phone:
Fax:
E-mail:
Physical Address:
City:
State:
Zip Code:
Mailing Address:(If Different)
City: State: Zip Code:
Shipping Address:(If Different)
City: State: Zip Code:
Type of Business: Date Business Commenced:
Sole Proprietorship:
Partnership:
Corporation:
Other:
Purchasing Agent: Email Address:
Payables Contact:
Email Address:
Sales Tax Exemption Number:
(Please attach a copy of the Certificate)
BANK INFORMATION
Bank Name:
Contact:
Phone:
Fax:
Email:
Checking Account Number: Savings Account Number:
BUSINESS/TRADE REFERENCES
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
E-mail:
Type of Account:
Company Name:
Address:
City: State: Zip Code:
Phone:
Fax:
E-mail:
Type of Account:
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
E-mail:
Type of Account:
AGREEMENT
SHOULD YOU APPROVE THIS APPLICATION, I (W E) AGREE TO PAY FOR ALL GOODS PURCHASED WITHIN THE GIVEN
NET 30 DAY TERMS ON EACH INVOICE. PACKARD INC. IS AUTHORIZED TO CONTACT ANY REFERENCES OR BANKS
LISTED ABOVE. IT IS UNDERSTOOD THAT ANY INFORMATION SO OBTA INED W ILL BE USED SOLELY FOR GRANTING
CREDIT. SERV ICE CHARGES AT THE HIGHEST RATE PERMITTED BY STATE LAW W ILL BE APPLIED TO PAST DUE
ACCOUNTS.
SIGNATURES
Title:
Date:
Title:
Date:
Credit Application
Business Account
Packard, Inc.
2700 Barrett Lakes Blvd. NW,
Suite 100
Kennesaw, GA 30144
Phone: [phone]
Fax: [phone]
custo merser vi [e-mail]
*Please email application and attachments to [e-mail].
Customer Number:
CREDIT APPLICATION FORM