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Credit Application For Business Account

Business Contact Information

Company Name *
Date Established *
EIN Number *
Primary Contact *
Title
Website
Phone *
 -
 -
Fax
 -
 -
E-Mail*
 
Mailing Address*
Billing Contact *
Title
Phone *
 -
 -
Fax
 -
 -
E-Mail*
 
Billing Address*
Organization Structure *
Sole proprietorship
Partnership      
Corporation  
Other:

Business & Credit Information

Physical Address*
How long at this address? *
Are You Exempt From Sales Tax? *
Yes
No
If Yes, Are You A Reseller or Non-Profit?
Reseller
Non-Profit
Phone *
 -
 -
Fax
 -
 -
E-Mail*
 
Bank name*
Phone *
 -
 -
Bank Address*
Type of Account*
Checking
Savings
Other:
Account Number *
 

Business/Trade Reference

Reference #1
Company Name *
Phone *
 -
 -
Fax
 -
 -
E-Mail*
 
Type of Account*
 
Mailing Address*
Reference #2
Company Name *
Phone *
 -
 -
Fax
 -
 -
E-Mail*
 
Type of Account*
 
Mailing Address*
Reference #3
Company Name *
Phone *
 -
 -
Fax
 -
 -
E-Mail*
 
Type of Account*
 
Mailing Address*

Documents


Please Email Any Additional Documents to:
Support@ZebraInstruments.com

With the Subject:
*Your Compny Name* - Credit Application

Items include but are not limited to:
Tax Exempt Forms
Credit Profiles


Agreement

The undersigned individuals authorizes inquiry as to credit information. We further acknowledge that credit privileges, if granted, may be withdrawn at any time.

Digital Signature*
 
Title *
 
Date*
Digital Signature*
 
Title *
 
Date*

Once submitted a representative from Zebra Instruments will be in touch shortly.
Upon Submission, you will be given the option to print a copy of your application. Please do so for your own record retention.