Credit Application

Legal Name of Applicant:
Date:
Trade Name:
Billing Address:
City:
State:
Zip:
Phone Number:
Fax:
Name of Accounts Payable Manager:
Phone Number:
Extension:
Retail Tax Exempt Number:
Line of Credit Requested:
We authorize Advanced Electronic Services, Inc. to investigate our credit history and financial responsibility through any credit bureau or through direct contact with past and present creditors. We agree to make payments in accordance with the terms set forth by Advanced Electronic Services, Inc. as shown on invoices issued by Advanced Electronic Services, Inc. We hereby agree to pay Advanced Electronic Services, Inc. all expenses including collection agency and attorney's fees incurred by Advanced Electronic Services, Inc. in connection with collection of any amounts due hereunder. Authorized Signature: Date:
*Application will not be processed without completing the above information.
Trader Supplied References
Reference 1:
Name:
Street:
City:
State:
Zip:
Phone Number:
Fax:
Reference 2:
Name:
Street:
City:
State:
Zip:
Phone Number:
Fax:
Reference 3:
Name:
Street:
City:
State:
Zip:
Phone Number:
Fax:
Please add any additional comments here: