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Portland Door Controls, Inc., Credit Application
Firm Business Name: __________________________________
Billing Address: __________________________________
Phone: __________________
Fax: ____________________
Corporation: _________Yes ___________ No
Year Incorporated: _________
Partnership: ________Yes ____________ No
Sole Proprietor: ________ Yes _________No
Name Of Principal Owner: ________________________________
Address: ____________________ City _________________ State ___
Phone: __________________ Title: ______________________
Trade References
Suppliers Name & Account Number: _________________________________________ Fax: ___________
Suppliers Name & Account Number: _________________________________________ Fax: ___________
Suppliers Name & Account Number: _________________________________________ Fax: ___________
Suppliers Name & Account Number: _________________________________________ Fax: ___________
I (WE) HAVE COMPLETED THIS APPLICATION TO OBTAIN, AND CERTIFY THAT ALL STATEMENTS CONTAINED THERE IN ARE TRUE AND CORRECT. I (WE) AGREE THAT CREDIT INQUIRIES MAY BE MADE AND AUTHORIZE THE RELEASE OF SUCH INFORMATION TO YOU. I (WE) UNDERSTAND AND AGREE THAT ANY CREDIT WE ACCUMULATE SHALL BE PAID PROMPTLY IN ACCORDANCE WITH THE CREDIT GRANTOR TERMS AND AGREEMENTS. I (WE) ALSO UNDERSTAND AND AGREE THAT CREDIT BALANCE NOT PAID IN ACCORDANCE WITH THE SAID TERM AND AGREEMENT. I (WE) ALSO AGREE, IN THE EVENT OF DEFAULT, TO PAY REASONABLE COLLECTION CHARGES, ATTORNEY FEES, AND COURT COSTS WHERE APPLICABLE.
SIGNED 1: ____________________________________________
SIGNED 2: ____________________________________________
PORTLAND DOOR CONTROLS, INC. TERMS: NET 30 DAYS
After completing Credit Application please fax to: 503/238-1614
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