Catalog - Electronic Fasteners Inc

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A Division Of Advanced Cable Ties, Inc. General Information APPLICATION FOR CREDIT MUST BE COMPLETED IN FULL AND SIGNED Attach Required Information: 4 Trade References, 1 Bank Reference and your resale/exempt use Certificate Mailing/Billing Address ___________________________________ Company Name ___________________________________ DBA (if different) ___________________________________ PO Box / Suite # ___________________________________ Street Address ___________________________________ City/Town State Zip ___________________________________________________________ **HD QTR NAME/LOCATION (IF DIFFERENT THAN ABOVE)** ___________________________________ Telephone Number ___________________________________ Fax Number ___________________________________ Federal I.D. No ___________________________________ DUNS # ***Tax exempt Yes______ No_______ (If Yes, you must submit a Resale certificate or Exempt useCertificate, otherwise application cannot be processed. See note below) *************************************************************************************** No. of years company been in business__________ Owner/President ___________________________ Owners Social Security No. _ _ _ - _ _ - _ _ _ _ Buyer Contact_________________________________ Accounts Payables Contact: ____________________ Phone No. For A/P: ___________________________ Fax No. For A/P: ___________________________ *************************************************************************************** Please note: It is Advanced Cable Ties, Inc.'s policy to collect legal and/or collection fees incurred for non-payment of debt. Massachusetts's law shall apply to all disputes, and all matters shall be litigated solely in Massachusetts' courts of law. The undersigned hereby authorizes their bank and attached credit references to disclose all details necessary to enable Advanced Cable Ties, Inc. to extend credit terms. The undersigned agrees to the payment terms and conditions stated on this credit application and current quote provided by Advanced Cable Ties, Inc. PLEASE SIGN AND PRINT YOUR NAME BELOW. _______________________________________________________________________________________ Authorized Signature (CEO/CFO/OWNER/BUYER/AGENT)TitleDate _______________________________________________________________________________________ Please print your name clearly I Advanced Cable Ties, Inc., 245 Suffolk Lane, Gardner, MA 01440 Tel: 1-800-861-7228 Fax: 1-978-630-3999 Web: www.actfs.com Email: sales@actfs.com 8
A Division Of Advanced Cable Ties, Inc. General Information ***We require a “Resale Certificate” or an “Exempt Use Certificate” with application; otherwise you will be charged sales tax. State laws require us to charge sales tax unless we have one of the above certificates on file. A “Sales and Use Tax Registration” does not exempt you from sales tax. CREDIT REFERENCE INFORMATION (To be completed by companies that don't have their own form) Name of Company applying for credit: _____________________________________________________ BANK REFERENCE: Name: _________________________________________________________________________________ Address: _______________________________________________________________________________ City: __________________________________ State: _________________ Zip Code: _______________ Phone: _________________________________ Fax: __________________________________________ Contact Person: _________________________________ Account Number: _______________________ TRADE REFERENCES: (4 Required) I Company Name:_________________________________________ Address:________________________________________________ City:____________________________________________________ State:_______________________Zip:________________________ Phone:__________________________________________________ Fax:____________________________________________________ Contact Person:__________________________________________ Company Name:_________________________________________ Address:________________________________________________ City:____________________________________________________ State:_______________________Zip:________________________ Phone:__________________________________________________ Fax:____________________________________________________ Contact Person:__________________________________________ Company Name:_________________________________________ Address:________________________________________________ City:____________________________________________________ State:_______________________Zip:________________________ Phone:__________________________________________________ Fax:____________________________________________________ Contact Person:__________________________________________ Company Name:_________________________________________ Address:________________________________________________ City:____________________________________________________ State:_______________________Zip:________________________ Phone:__________________________________________________ Fax:____________________________________________________ Contact Person:__________________________________________ 9 Tel: 1-800-861-7228 Fax: 1-978-630-3999 Web: www.actfs.com Email: sales@actfs.com
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Catalog - Electronic Fasteners Inc

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