| National Technology Services, Inc. | |||||||||||
| 15 Redstone Ridge | |||||||||||
| Voorhees NJ 08043 | |||||||||||
| Phone: (856) 809-1900 Fax: (856) 753-7978 | |||||||||||
| CREDIT APPLICATION | |||||||||||
| COMPANY NAME | Date:___________________ | ||||||||||
| DBA: | |||||||||||
| Billing | Shipping | ||||||||||
| Address | Address | ||||||||||
| Phone # | _______________________Fax #________________________FED ID or SS#______________________________ | ||||||||||
| ____ Corporation | ____ Partnership | ____ Proprietorship | Credit Amt Requested:$_____________ | ||||||||
| COMPANY OFFICERS/PRINCIPALS: | |||||||||||
| 1 | Title | ||||||||||
| 2 | Title | ||||||||||
| 3 | Title | ||||||||||
| PERSONS AUTHORIZED TO SIGN | CONTRACTS: | ||||||||||
| 1 | Title | ||||||||||
| 2 | Title | ||||||||||
| Does your company require the use of purchase orders? | Yes | No | |||||||||
| ACCOUNTS PAYABLE CONTACT: | Title: | ||||||||||
| CREDIT REFERENCES -List names & addresses of your bank and AT LEAST (3) suppliers with whom you have an account. | |||||||||||
| BANK NAME | BANK CONTACT: | ||||||||||
| Address | ACCT # | ||||||||||
| Zip _____________ | ACCT # | ||||||||||
| Phone# | Fax # _____________________ | ||||||||||
| SUPPLIER NAME | SUPPLIER NAME | ||||||||||
| Address | Address | ||||||||||
| Zip _____________ | Zip __________ | ||||||||||
| Phone# | Fax # _____________________ | Phone# | Fax # __________________ | ||||||||
| Account #_____________________ | Account #_____________________ | ||||||||||
| SUPPLIER NAME | SUPPLIER NAME | ||||||||||
| Address | Address | ||||||||||
| Zip _____________ | Zip __________ | ||||||||||
| Phone# | Fax # _____________________ | Phone# | Fax # __________________ | ||||||||
| Account #_____________________ | Account #_____________________ | ||||||||||
| IF YOU ARE TAX EXEMPT - PLEASE COMPLETE AND RETURN THE FOLLOWING TAX EXEMPTION CERTIFICATE. | |||||||||||
| BY FEDERAL LAW, NO SALES TAX DEDUCTIONS CAN BE AUTHORIZED WITHOUT THIS FORM ON FILE. | |||||||||||