Account Setup

*Account Name
*Address
*City   *State   *Zip  
*Home Phone Business Phone
Cell Phone Fax
Email
A/P Contact A/P Phone
A/P Fax A/P Email


Authorized Users on This Account

Auth User Name

 

Legal

Legal Status
Type Business
Tax Status

 

Credit References

Reference Name Reference Phone
Reference Address Reference Account
Reference Name Reference Phone
Reference Address Reference Account

Officers / Owners of Company

Owner Name Owner Phone
Owner Address
Owner Name Owner Phone
Owner Address

Bank References

Bank Ref Name
Bank Ref Location
Bank Ref Phone
Bank Ref Fax

TERMS: APPLICANT ATTSTS FINANCIAL RESPONSIBILITY AND AGREEMENT TO PAY INVOICES IN ACCORDANCE WITH THE TERMS SET FORTH BY CYMBIDIUM. TERMS SET FORTH AT THE TIME OF THE APPLICATION ARE ALL INVOICES DUE UPON RECEIPT. ANY INVOICES UNPAID AFTER THRITY DAYS WILL BE SUBJECT TO A 3% FINANCE CHARGE, AND THEN BILLED TO THE GUARANTER'S CREDIT CARD ACCOUNT.