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Get New Customer Application - Ei - Lo

CITY: WEB ADDRESS: DATE ESTABLISHED: CONTACT/BUYER: EMAIL: PHONE: FAX: EMAIL: A/P CONTACT: PHONE (IF DIFFERENT): FAX (IF DIFFERENT): SHIP TO ADDRESS (IF DIFFERENT): STATE: CITY: ZIP: TERMS CREDIT CARD (CC AUTHORIZATION FORM REQUIRED) COD COMPANY CHECK COD MONEY ORDER/CASHIERS CHECK NET 30 LIMIT $ COD COMPANY CHECK AND NET 30 APPLICANTS PLEASE COMPLETE THE BANK AND TRADE REFERENCE BELOW. CREDIT DECISION CAN TAKE UP TO 10 BUSINESS DAYS. ALL INFORMATION PROVIDED WILL BE HELD IN STRIC.

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