Credit Application

Company Name:

Organized as (Select One):

Address:
City: State: Zip:

Country:

Phone: Fax: Duns #:

Billing Address (if different):

Address:
City: State: Zip:

Country:

Nature of Business:

Date Business Started (mm/dd/yy): State of Incorporation: Sales Tax Exemption #:

Estimated Annual Sales: Estimated Annual Purchases:

Officers, Proprietors or Partners of the firm:
      1.
      2.
      3.

Contact for Invoice Inquiries:
Phone: E-mail:

 

References: (U.S. References preferred)

Name: Address: Telephone #: Fax #:

 

Name of Bank:
Address of Bank:
Account #:
Contact Name:
Phone#:

 

By signing this application, I hereby attest to accepting and understanding the following terms and conditions on behalf of the requesting organization named above:

Any and all payments related to this agreement are due no more than 30 days following receipt of an invoice.
In the event that the requesting organization's account associated with this agreement must be placed with a third party collector, the requesting organization shall be responsible for all associated costs, including any and all reasonable attorney's fees, and court costs.

I hereby authorize the IEEE to investigate the requesting organization's credit history and bank references in order to facilitate the extension of credit by the IEEE. Further, I agree that the requesting organization shall immediately notify the IEEE of any change in ownership, address or form of incorporation. This agreement shall remain in full force and effect until such time as the requesting organization provides the IEEE with written revocation of same.

By clicking the Submit button, I am agreeing to the terms above. I understand that my application will not be processed until the credit application is approved.