Legal form of business:
Corporation Partnership Franchise Proprietorship

 

If subsidiary, please provide name & address of parent company:
Is a Purchase Order required?	Yes    No
Name of person invoice is to be mailed to:
Name of Webcom sales representative if known:
For U.S. Companies:
Is corporation registered with Secretary of State:	Yes    No
Federal Tax ID#
If Yes, give date and State of incorporation

Principals:

Name: Title:
Name: Title:
Name: Title:

 

Name of Bank:
Address:
Telephone #:
Bank Manager:
Account #:

 

Principal Supplier:
Address:
Telephone #: (include area code)
Fax #:
Contact Name:
Principal Supplier:
Address:
Telephone #: (include area code)
Fax #:
Contact Name:
Principal Supplier:
Address:
Telephone #: (include area code)
Fax #:
Contact Name:

Credit line requested ($)
*This is the maximum amount of credit that at any point in time, you wish Webcom to grant under approved credit terms.

1. Standard Terms of sale are net 30 days.
2. Special Terms being requested
   *All special terms need to be approved in writing by the Webcom Credit Department.
3. Interest will be charged on past due accounts at the rate of 1% per month or 12% per year.
4. NSF cheques will be subject to a $25.00 charge.
5. Failure to comply with these terms and conditions may result in cancellation of credit privileges without further notice.
6. Applicant agrees to bear all costs incurred in collecting any unpaid amounts including, but not limited to, collection agencies, legal fees and court costs.
7. The information given in this application and agreement is warranted to be true and correct and given for the purpose of obtaining credit.
8. The Applicant consents to the obtaining of credit and/or personal information as may be required in connection with the credit line hereby applied for or any credit reporting agency or to any person with whom the Applicant has, or proposes to have, financial relations.