CREDIT APPLICATION ::
Please submit your credit application by
downloading
and FAXing the credit application or submitting the credit applacition below.
1. Company Information
Name *
Company *
E-mail *
Phone *
Fax
Address *
2. Billing Address
(If Different)
Company *
Address
- - Same As Above - -
3. Company Ownership Information
Business Type
Corporation
Partnership
Sole Proprietorship
Individual
.
State Incorporated
..
Date Bus. Started
Nature of Business
Principal / Officer
Title
SS#
1
2
3
4. Banking & Finance Reference
Bank Name
Address
5. Account Numbers
Checking
Savings
Dun & Bradstreet #
6. Trade References
Company Name
Contact
Phone #
1
2
3
I agree
I understand and agree to the following terms: The above is true and is
submitted for the purpose of opening an account with 11th Hour Express. This
will authorize 11th Hour Express to verify the above information. This
account will be billed twice per month, and payment is due within 10 days of
the billing date. Applicant agrees to pay all monies due within terms
granted, along with agreeing to pay for any collecton expenses including
administrative cost, court cost, and attorney fees due to non payment.
* Required