Environmentally Friendly Odor, Pollution & Moisture Control Products
Safe • Reusable • Recyclable • Non-Toxic • Odorless • Natural • Sustainable
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NoOdor.com
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| 770.667.8621 |
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Environmentally Friendly Odor, Pollution & Moisture Control Products Safe • Reusable • Recyclable • Non-Toxic • Odorless • Natural • Sustainable |
|
FAX Credit Application Form
Please print out this form, fill out completely and fax to IMTEK at:
(770) 667-8683.
Name_________________________________________________________ Title_________________________________________________________ Company_________________________________________________________ Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________ FAX_________________________________________________________ E-mail_________________________________________________________
PRINCIPALS (if corporation, list officers, if partnership, list partners)
1. Name_________________________________________________________ Title_________________________________________________________ Home Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________---------
2. Name_________________________________________________________ Title_________________________________________________________ Home Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________----------
3. Name_________________________________________________________ Title_________________________________________________________ Home Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________
SALES TAX STATUS (Please check one)
Not Tax Exempt____ Tax Exempt ____ Tax Exempt Number__________________
BANK REFERENCE
Bank Officer_________________________________________________________ Bank Name_________________________________________________________ Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________ Account #_________________________________________________________
TRADE REFERENCES
1. Contact Name_________________________________________________________ Company_________________________________________________________ Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________----------
2. Contact Name_________________________________________________________ Company_________________________________________________________ Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________----------
3. Contact Name_________________________________________________________ Company_________________________________________________________ Address_________________________________________________________ City_________________________________________________________ State_________________________________________________________ Zip_________________________________________________________ Country_________________________________________________________ Phone_________________________________________________________
BUSINESS INFORMATION
Individual ____ Partnership ____ Corporation ____ Type of Business___________________________________ Number of Employees________________________________ Years in Business__________________________________ Annual Sales $_____________________________________ D+B Listed? Yes____ No____ Amount of Credit Requested $ ______________________
BY COMPLETING THIS APPLICATION FOR CREDIT, THE APPLICANT:
1. Attests financial responsibility, ability and willingness to pay all invoices
2. Hereby Authorizes IMTEK ENVIRONMENTAL CORP. to investigate
in accordance with the following terms: 2% 10; Net, 30 days, service charges will be
paid at the rate of 1.5% (18% annual rate) on all balances over 30 days.
the references listed pertaining to the applicant's credit and financial responsibility and
obtain additional information by securing data from a credit reporting agency.3. Hereby Agrees that should it become necessary to assign the applicant's
account to a licensed collection agency or atttorney for legal action, all subsequent
collection charges and legal fees shall be paid by the applicant.4. Hereby Authorizes the seller, its successors and assigns, by the seller's
designated attorney to waive the issuance of process and confess judgment against the
applicant for the entire unpaid balance of applicant's account together with all costs
applicable to such action.5. Certifies and Warrants that the information given in this application is true and
correct and is given for the purpose of obtaining credit.
Applicant Name________________________________________ Position____________________________________ Date________________ Applicant Name________________________________________ Position____________________________________ Date________________
IMTEK Environmental Corporation, PO BOX 2066, Alpharetta, GA 30023 USA | imtek.biz | service@imtek.biz | 770.667.8621 o | 770.667.8683 f | IMTEK Business Units: NoOdor.com | SaniBulb.com | CarbonFootprint360.com | Govations.com | OnlineMSDS.com | eFilz.com | Mivabiz.com | Gomagine.com IMTEK is a Carbon Neutral Company. Copyright © 2008-2009 Imtek Environmental Corporation. All rights reserved Designed & Developed by MIVABIZ
We accept all credit cards
