Catalog - Electronic Fasteners Inc
Catalog - Electronic Fasteners Inc
Catalog - Electronic Fasteners Inc
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A Division Of Advanced Cable Ties, <strong>Inc</strong>.<br />
General Information<br />
APPLICATION FOR CREDIT<br />
MUST BE COMPLETED IN FULL AND SIGNED<br />
Attach Required Information: 4 Trade References, 1 Bank Reference and your resale/exempt use Certificate<br />
Mailing/Billing Address<br />
___________________________________<br />
Company Name<br />
___________________________________<br />
DBA (if different)<br />
___________________________________<br />
PO Box / Suite #<br />
___________________________________<br />
Street Address<br />
___________________________________<br />
City/Town State Zip<br />
___________________________________________________________<br />
**HD QTR NAME/LOCATION (IF DIFFERENT THAN ABOVE)**<br />
___________________________________<br />
Telephone Number<br />
___________________________________<br />
Fax Number<br />
___________________________________<br />
Federal I.D. No<br />
___________________________________<br />
DUNS #<br />
***Tax exempt Yes______ No_______<br />
(If Yes, you must submit a Resale certificate or<br />
Exempt useCertificate, otherwise application<br />
cannot be processed. See note below)<br />
***************************************************************************************<br />
No. of years company been in business__________ Owner/President ___________________________<br />
Owners Social Security No. _ _ _ - _ _ - _ _ _ _ Buyer Contact_________________________________<br />
Accounts Payables Contact: ____________________ Phone No. For A/P: ___________________________<br />
Fax No. For A/P: ___________________________<br />
***************************************************************************************<br />
Please note: It is Advanced Cable Ties, <strong>Inc</strong>.'s policy to collect legal and/or collection fees incurred for<br />
non-payment of debt. Massachusetts's law shall apply to all disputes, and all matters shall be litigated<br />
solely in Massachusetts' courts of law.<br />
The undersigned hereby authorizes their bank and attached credit references to disclose all details<br />
necessary to enable Advanced Cable Ties, <strong>Inc</strong>. to extend credit terms. The undersigned agrees to the<br />
payment terms and conditions stated on this credit application and current quote provided by<br />
Advanced Cable Ties, <strong>Inc</strong>.<br />
PLEASE SIGN AND PRINT YOUR NAME BELOW.<br />
_______________________________________________________________________________________<br />
Authorized Signature (CEO/CFO/OWNER/BUYER/AGENT)TitleDate<br />
_______________________________________________________________________________________<br />
Please print your name clearly<br />
I<br />
Advanced Cable Ties, <strong>Inc</strong>., 245 Suffolk Lane, Gardner, MA 01440<br />
Tel: 1-800-861-7228 Fax: 1-978-630-3999 Web: www.actfs.com Email: sales@actfs.com<br />
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