NEQP Application for Credit

Fill out form and press "SEND" or print this page, fill it out and fax to 978-462-6033.

BY
Name of Firm or Individual
Account #
Address
City
State/Zip
Years at this address
Phone
The following information must be provided. It will be held in the strictest confidence.
OWNERSHIP
Corporation	Incorporated within last 12 months
Partnership	Individual
Name(s) of Principal(s)
Gross Sales
Number of Employees
How Long in Business
FINANCE
Bank
Bank Officer Department
Bank Address
Zip
Account #
Phone
Fax
REFERENCE
(1) Business Name
Complete Address
Contact
Phone
Fax
(2) Business Name
Complete Address
Contact
Phone
Fax
(3) Business Name
Complete Address
Contact
Phone
Fax
NEQP TERMS
First Order Prepaid. Normal Credit Terms 1% 15 Net 20 Days. Tax excempt Certificate Must Accompany This Application.
We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.
(Signed)
Date
(Title)

 

 

We accept Visa, Master Card & American Express

  
Please do not write in the space below.

VERIFICATION
References Checked By
Credit Approved By
References Results
Credit Refused By
Date

 

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