eToner.com
CREDIT
APPLICATION
Print
and fax to: 800 289 8083 or mail to eToner.com, PO Box 1349, New Milford
CT 06776 OR
click here to
apply Online
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| Business Name | |
| Address | |
| City / State | Zip Code |
| Contact person (Purchasing) | |
| Phone | Fax |
| Contact person (Accounts Payable) | |
| Phone | Fax |
| Federal tax ID or Social Security number. | |
| Type of business | No. of employees |
| Date business established | |
| Types of products you will purchase | |
| Are you a (circle one):
CORPORATION PARTNERSHIP SOLE PROPRIETORSHIP State of Incorporation ______________ Names, titles, and addresses of your three chief corporate officers (or partners) Are you sales tax exempt (circle one)? Yes No Names of authorized purchasers Purchase order required (circle one)? Yes No |
| Name | |
| REFERENCE #1 | Address |
| Phone | |
| REFERENCE #2 | Name |
| Address | |
| Phone | |
| REFERENCE #3 | Name |
| Address | |
| Phone | |
| BANK REFERENCES | Account # |
| BANK #1 | Contact Person Phone |
| Name of Bank Address: | |
| I represent that the above information is true and is
given to induce to extend
credit to the applicant. My company and I authorize to make such credit investigation
as sees fit, including
contacting the above trade references and banks and obtaining credit
reports. My company and I authorize all trade references, banks, and
credit reporting agencies to disclose to any and all information concerning
the financial and credit history of my company and myself. I have read the terms and conditions stated below and agree to all of these terms and conditions. | |
| Printed name: | Authorized signature: |
| Title: | Date: |