Sunday, December 17, 2017

Credit Account Application

Generated with MOOJ Proforms Basic Version 1.3
Please fill in all Applicable Spaces:
Partnership
Individual
Corporation
Resale Card Encl.
Taxable
Firm or Trade Name
President
Treasurer
Business Address
City/State
Zip
Billing Address
City/State
Zip
Type of Business
Manager's Name
Phone Number
Bank Name
Account Number
Address
City/State
Zip

CREDIT INFORMATION - LIST 3 REFERENCES

(1) Name
(1) Phone Number
(1) Address
(1) City/State
(1) Zip
(2) Name
(2) Phone Number
(2) Address
(2) City/State
(2) Zip
(3) Name
(3) Phone Number
(3) Address
(3) City/State
(3) Zip

TERMS AND CONDITIONS OF SALES

Net 30 Days From Invoice Date

Do you require a purchase order number?
Who is authorized to place a job order?

I hereby agree to all the terms and conditions of this application and state that all information given to Adelphia Inc. Chandler's Air Conditioning and Refrigeration is correct.

Print Name
Social Security Number
Signature
Title
Date
Home Address
City
State
Zip
Home Phone
Designed for Chandlers AC 2013