Advanced Equipment Company-Credit App

ADVANCED EQUIPMENT COMPANY
P.O. Box 11382
Charlotte, NC 28220
PHONE 704-527-3141 FAX 704-522-7262
Email: aec1@att.net
http://www.aec-carolinaonline.com

PLEASE FILL OUT THE FOLLOWING CREDIT APPLICATION, PRINT, AND FAX IT TO: ADVANCED EQUIPMENT COMPANY @ 704-522-7262

APPLICATION FOR CREDIT

DATE:_______________________

ISSUED TO: ADVANCED EQUIPMENT COMPANY

FIRM NAME: (NAME OF FIRM REQUESTING STATEMENT)
___________________________________________________________________________________

MAILING ADDRESS: _____________________________________ PHONE:____________________

CITY: __________________ STATE: ______________ ZIP CODE: ____________________________

DUN & BRADSTREET REFERENCE NUMBER ___________________________________________
(IF D&B NUMBER IS PROVIDED - NO FURTHER INFORMATION IS NECESSARY)

FULL NAME OF OWNER OR OWNERS (OR AN AUTHORIZED OFFICER OF CORPORATION)
LIST HOME ADDRESS & ZIP CODE FOR PARTNERSHIP OR INDIVIDUAL.
1._________________________________________________________________________________

2._________________________________________________________________________________

PLEASE CHECK ONE:

INDIVIDUAL

PARTNERSHIP

CORPORATION

FED. TAX NO.

TRADE REFERENCES

NAME MAILING ADDRESS CITY STATE ZIP

1)___________________________________________________________________________________

2)___________________________________________________________________________________

3)___________________________________________________________________________________

NAME OF BANK:
CONTACT:
ACCOUNT NO:
MAILING ADDRESS:
CITY / STATE / ZIP

APPLICANTS SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH FOLLOWING TERMS: NET 10

FIRM NAME:

BY:		TITLE: