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January 21, 2018
Phone: 785-232-8705
Credit Application

 

Business Contact Information

 
Company Name:                                                                       Owner:
Billing Address:
City:      State:      Zip:                              Federal Tax ID:
Shipping Address:
City:      State:      Zip:                              Website:
Phone:      Fax:      E-Mail    
Account Payable Contact:      Phone:      Email:
 

Bank Information

 
Name of Bank:                                        Contact:
Address:      City:      State:      Zip:     
Phone:      Fax:      Account Number:     
 

Business References

 
Company:      Phone:      Fax:    
Address:      City:      State:      Zip:    Contact:  
 
Company:      Phone:      Fax:    
Address:      City:      State:      Zip:    Contact:  
 
Company:      Phone:      Fax:    
Address:      City:      State:      Zip:    Contact:  
 
 
Pending credit approval transactions must be paid by credit card or C.O.D All invoices are to be paid 30 days from the date of the invoice. Any account not adhering to the current "Terms Of Credit" maybe placed on C.O.D at TMi, Corp.'s discretion. By submitting this application, you authorize TMi, Corp. to make inquiries into the business references that you have supplied. The applicant acknowledges that all information contained herein is accurate and current. All information will be kept confidential.
 
Signature of Applicant:      Title:      Date: