Credit form


110 West Lake Street / Mt. Shasta, CA 96067 / 530-926-2244, Fax: 530-926-6343
This section for Alpine Credit Department only
	Customer Account No... Credit Limit..... Approved by................. Date Entered...
*Credit Application: Fill out. Print out. Fax to 530-926-6343*
	Company Name.... Telephone... Address................ Fax............. Mailing Address.... Cell............. City, State, Zip...... Year Established.. Corporation Partnership Sole Proprietorship Prior address if less than 1 year... Parent Company if any................
*Credit References*
	Bank Reference Bank Name.......... Account No... Contact................ Phone..... Address............... Fax........ City, State, Zip..... Trade Reference Name................... Phone..... Address............... Fax........ City, State, Zip..... Trade Reference Name................... Phone..... Address............... Fax........ City, State, Zip..... Trade Reference Name................... Phone..... Address............... Fax........ City, State, Zip.....
*Authorized individuals*
	Name................... Phone..... Name................... Phone..... Name................... Phone..... Applicant's signature attests responsibility, ability and willingness to pay invoices within accordance of Alpine Business Equipment's terms. Terms: Net 15th of month following invoice date; 1.5% monthly late charge on past due amounts (minimum charge of $.50) The above information is for the purpose of obtaining credit and is warranted to be true. I hereby authorize Alpine Business Corporation dba Alpine Business Equipment to investigate the listed references. I further agree to be personally liable for reasonable legal and collection expenses. Date... Signature... Title...
Print this form and fax it to Alpine Business Equipment, 530-926-6343