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.