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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@ZebraHVAC.com

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

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


Agreement

The undersigned 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 We further acknowledge that credit privileges, if granted, may be withdrawn at any time.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 HVAC 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.