Credit Application | TM Track Machines

Billing Information:

Application Type*

Name*

First Last

Company Name*

DBA

Country

Street Address*

Street Address Line 2

City*

State/Province*

Zip/Postal Code*

Phone Number*

Fax Number

Email

Company Web Address

Accounts Payable Contact Name*

Accounts Payable Contact Phone*

Business Type*

LLC*

Federal ID Number*

Goods & Services Tax Number*

Are you sales tax exempt?*

Sales Tax Resale Number*

State*

Please attach exemption certificate*

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB.

P.O. Required*

Total Years in Business*

How many years in business at current location?*

Have you ever filed bankruptcy?*

if yes, when?*

Have you received credit from this company before?*

Under what name?

Dun & Bradstreet Number

Bank Reference:

Bank Reference*

Attachment for Bank Reference*

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB.

Name of Bank*

Country

Street Address*

Street Address Line 2

City*

State/Province*

Zip/Postal Code*

Phone #*

Email Address

Fax #

Account #*

Company Credit References (Do not list credit card)

Company Credit References*

Attachment for Credit Letter*

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 32 MB.

Company 1*

Country

Street Address*

Street Address Line 2

City*

State/Province*

Zip/Postal Code*

Phone #*

Email Address

Fax #

Company 2*

Country

Street Address*

Street Address Line 2

City*

State/Province*

Zip/Postal Code*

Phone #*

Email Address

Fax #

Company 3*

Country

Street Address*

Street Address Line 2

City*

State/Province*

Zip/Postal Code*

Phone #*

Email Address

Fax #

IT IS AGREED:

1. Purchaser will promptly notify TM Track Machines of any change in the undersigned's legal status.

2. Purchaser agrees to pay invoices due within the terms stated on the invoice. If invoices are not paid within terms extended, account will be placed on a cash basis until account is paid in full.

3. Purchaser agrees to pay costs of collection of any unpaid account, including reasonable Attorney’s fees and costs incurred to effect collection, with or without suit, including preparation, filing and foreclosure of any liens.

4. A minimum interest charge of 1/2% per month (18% per annum) will be assessed on all past due invoices.

I hereby agree to abide by foregoing terms that the above information is true and complete. TM Track Machines is authorized to contact credit references provided and to obtain any further credit information needed to substantiate credit requested.

Name*

First Last

Title*

Signature*

Date*

CORPORATION

If you are a corporation the application must be signed by an officer of the corporation. He/She must sign on all for lines. (Company and individual)

Company Name:*

Signed by:*

First Last

Signature*

Title*

Date*

The Finance Department Requires 48 Hours to Process This Application.
Failure To Provide Complete Information May Delay Credit Approval.

Name

This field is for validation purposes and should be left unchanged.