Credit Application

Credit Application

Resellers Credit Application

Company Name
DBA Name
Telephone Number
Fax
Street Address
PO Box
City
State/Province
Zip Code
E-mail Address
Internet URL
Principle Name & Title
Principle Name & Title
Years operating as named business:
Resale number or seller's permit:
Bank Reference
Bank Name
Address
Account Number
Type	Savings Checking
Account Number
Type	Savings Checking
Trade References
Name
Phone Number
Contact
Relationship
Name
Phone Number
Contact
Relationship
Name
Phone Number
Contact
Relationship
Credit Policy
All invoices are payable upon receipt. Invoices are issued monthly on the last Friday of the month. All information received through use of this form is strictly confidential. Any modifications to Steel City Telecom's credit policy will be sent to all participants and will be considered accepted unless responded to in writing.
I affirm that all information provided is true and correct and I have read the credit policy as stated.
Name
Title
Date

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