Credit Application
Filling out this form will allow the use of Purchase Orders
P.O.'s may be faxed to 203-881-3075
*
- Required Data
Incomplete Applications will be rejected!
*
Company's Name
*
Address
*
City
*
State/Province
Anticipated
Annual Sales
*
Zip
*
Phone
*
Email
*
Fax
Type of
Ownership:
Corporation
Partnership
Sole Propietor
Limited
Company
Person to Contact for Information
Purchasing
Accounts Payable
No. of years
in business:
Listed in D&B?
Yes
No Dun's No.
Your purchases are taxable?
Yes
No
Bank References
*
Name
*
Phone/Fax
*
Address
*
City
*
State/Province
*
Zip
*
Person to Contact
*
Account Number
Major Suppliers' References
(Please Furnish Complete Address)
1.
*
Name
*
Phone
*
Fax
*
Address
*
City
*
State/Province
*
Zip
*
Person to Contact
*
Phone
*
Account Number
2.
*
Name
*
Phone
*
Fax
*
Address
*
City
*
State/Province
*
Zip
*
Person to Contact
*
Phone
*
Account Number
Info Request/Comments:
Terms of Sale are Net 30 Days or 1.5% per month thereafter as agreed upon with our Credit Department.
This is authorization for
Action Scale
to obtain credit information from the above listed references. We understand your terms of sale and agree to abide by them.
*
Your Name
*
Title
*
Date
Information obtained from the above references will be treated as confidential.