"A Quality Component Distributor"

 
 

APPLICATION FOR CREDIT
PLEASE SUPPLY ALL INFORMATION REQUESTED

* Required Information

FIRM:

 

PARENT:

 

BILLING ADDRESS:

 

CITY:

 

STATE:

 

ZIP:

 

SHIPPING ADDRESS:

 

CITY:

 

STATE:

 

ZIP:

 

PHONE:

 

FACSIMILE:

 


YEAR ESTABLISHED:

 

STATE INCORPORATED IN:

 

AMOUNT OF CREDIT REQUESTED:

 

MERCHANDISE FOR RESALE:

 YES or NO -

TYPE OF BUSINESS:

 

OFFICER:

 

TITLE:

 

OFFICER:

 

TITLE:

 


SUPPLIER REFERENCES:

NAME:

 

ADDRESS:

 

CITY:

STATE:

 

ZIP:

 

   

NAME:

 

ADDRESS:

 

CITY:

 

STATE:

 

ZIP:

 

   

NAME:

 

ADDRESS:

 

CITY:

 

STATE:

 

ZIP:

 

   

BANK REFERENCES:

NAME:

 

ADDRESS:

 

CITY:

 

STATE:

 

ZIP:

 


 

The above information is given for the purpose of obtaining credit and is warranted to be true.  We hereby authorize U.S.Connections, Inc. to investigate the references cited, pertaining to my/our credit and financial responsibility.
I/We further agree to pay to the terms cited on each U.S.Connections, Inc. invoice for payment.

EXCUTED BY:

 

EMAIL ADDRESS:

 

TITLE:

 

DATE:

 

* Please note that because credit processing requires two weeks, your initial order will be
    shipped COD

 
 

 

Corporate Headquarters

6004 Breen Dr.
Houston, Texas 77086
Phone: (281) 272-2020
Fax: (281) 272-2230

E-mail: info@usconnectionsinc.com