Credit application

Specializing in Hardware/Software
Network Security Solutions for Computers & Internet

If you prefer, you may print & fax this form to 925-685-1760.

All fields must be completed, incomplete forms can not be processed.

Firm's Legal Name:

DBA:

Address:

City:

State:

Zip:

Email:

Phone:

Fax:

Website:

Full Name of Owner or Owners', or an Authorized Officer if Corporation:

Please check one:

Proprietorship

Partnership

Corporation

Does your company have a branch or subsidiary located in Calif.: Yes No

Federal Tax ID#:

Dunn & Bradstreet #:

Type of Business:

Date Started:

Est. Annual Sales:

Accts Payable Contact:

Phone #:

Credit Limit Desired:

Credit Terms:

Net 15

Net 30

- TRADE REFERENCES -

Name:
Address:
City:
State:
Zip:
Email:
Phone:

Name:
Address:
City:
State:
Zip:
Email:
Phone:

Name:
Address:
City:
State:
Zip:
Email:
Phone:

Name:
Address:
City:
State:
Zip:
Email:
Phone:

BANK INFORMATION

Name of Bank:

Account #:

Street Address:

City:

State:

Zip:

Contact:

Phone:

If the information wherein this agreement is not paid by the date indicated, and it is necessary to take steps to collect on this debt, then the customer agrees to pay all reasonable collection costs, including attorney fees, which are necessary to collect the debt. These terms and conditions and the sale subject hereto shall be governed by the laws of the State of California without regard to its conflict of laws and principles. In the event any proceedings or suit is brought regarding these terms and conditions and the sale subject hereto, such suit shall be brought in the courts of San Mateo County, California, the parties hereby agree to personal jurisdiction in said court(s).The person signing/submitting this application certifies that all the application contained in this application and any attachments, is true and correct to the best of their information, knowledge, and belief and that they are authorized to sign on behalf of their company. The person signing/submitting this application authorizes the above references to release the applicable credit information.

Bay Area Network Security is a subscriber to
Dun&Bradstreet's Commercial Collection Services

Firm Name:

Your Name:

Title:

By entering your name above, you are entering your signature, which is legally binding. Your IP address is also being logged to protect against fraud.

Specializing in Hardware/Software Network Security Solutions for Computers & Internet

CREDIT APPLICATION

Specializing in Hardware/Software
Network Security Solutions for Computers & Internet