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Customer Credit Application
 
 
		
General Information
Bill To Address
Company Name:*
Address 1:*
Address 2:
City:
State:
Zip:
Phone:
Fax:
Email:*
 
Job Site Address
Company Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
 
Tax ID Number:
State Tax Number:
Company Form:
Corporation
Partnership
Sole Proprietor
Other (Specify)
Taxable?
Yes
No
If no, attach a copy of exemption certificate.
Purchase Orders Required?
Yes
No
ASI Representative:
 
Contacts
Buyer:
Title:
Phone:
 
Accts Payable:
Title:
Phone:
 
President/CEO:
Title:
Phone:
 
Other:
Title:
Phone:
 
Other:
Title:
Phone:
 
References
Bank:
Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Contact Name:
Acct Number:
 
References (continued)
Trade #1:
Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Contact Name:
Acct Number:
 
Trade #2:
Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Contact Name:
Acct Number:
 
Trade #3:
Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Contact Name:
Acct Number:
 
Payment Terms
Our company agrees to pay All Systems Installation invoices according to their payment terms of net 30 days. If our company does not comply with these terms, we will pay a 1.5% monthly (18% Annual Percentage Rate) finance charge on the unpaid balance.
Authorized By:
Title:
Date:
This application will not be accepted without proper authorization.
 
Credit established upon approval.
 


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Twin Cities Office
8300 10th Avenue North, Suite A
Golden Valley, MN 55427
Tel: 763.593.1330
Toll Free: 800.778.5632
Fax: 763.593.9980
Rochester Office
929 37th Avenue Northwest
Rochester, MN 55901
Tel: 507.281.9466
Toll Free: 800.359.9468
Fax: 507.281.9266
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All products and brand names are trademarks or registered trademarks of their respective holders.