SJE-Rhombus

SJE-Rhombus Credit Application

 

PLEASE FILL OUT THIS APPLICATION IN ITS ENTIRETY.  Information given below will be held confidential and is exclusively for our use.

This application must be filled out in English.

  SJE-Rhombus CREDIT APPLICATION
 
Company Name: A value is required.
(if Subsidiary)
Parent Company:
Parent Address: A value is required.
City: A value is required.
State: A value is required.
Postal Code: A value is required.Please enter a five digit zip code.
Billing AP Contact Telephone: A value is required.Invalid format. (xxx) xxx-xxxx
Fax: A value is required.Invalid format. (xxx) xxx-xxxx
EIN (FED ID #): A value is required.
Shippng Address: A value is required.
City: A value is required.
State: A value is required.
Postal Code: A value is required.Please enter a five digit zip code.
Telephone: A value is required.Invalid format. (xxx) xxx-xxxx
Fax: A value is required.Invalid format. (xxx) xxx-xxxx
Full Name and Title
of Person Requesting Credit:
A value is required.
E-mail Address: A value is required.Please enter a valid e-mail address.
Requested Credit Limit: A value is required.
Sales Manager: A value is required.
Authorized Purchasing Agent: A value is required.

What do you estimated your monthly purchases to be?

A value is required.
Type of Organization: Please select an item.
Material Purchased For: Please select an item.
Type of Business: Please select an item.
Resale Certificate #
State Issued:
Number of Years in Business: A value is required.
Listed in Dun & Bradstreet?

Please make a selection.
if Yes, List D&B Number:
   
  PRINCIPAL OWNER:
Full Name: A value is required.
Physical Address: A value is required.
City: A value is required.
State: A value is required.
Postal Code: A value is required.Please enter a five digit zip code.
Phone: A value is required.Invalid format. (xxx) xxx-xxxx
Fax: A value is required.Invalid format. (xxx) xxx-xxxx
If there are additional owners please enter their full name, full address and phone numbers in the field below:
 
   
  BANK REFERCE:
Full Bank Name: A value is required.
Account Number: A value is required.
Address: A value is required.
Contact: A value is required.
City: A value is required.
State: A value is required.
Postal Code: A value is required.Please enter a five digit zip code.
Phone: A value is required.Invalid format. (xxx) xxx-xxxx
Fax: A value is required.Invalid format. (xxx) xxx-xxxx
   
  TRADE REFERENCES: Please list references (USA refrences preferred)
  Reference 1
Company Name:
Contact:
Address:
City:
State:
Postal Code:
Phone:   (xxx) xxx-xxxx
Fax:   (xxx) xxx-xxxx

  Reference 2
Company Name:
Contact:
Address:
City:
State:
Postal Code:
Phone:   (xxx) xxx-xxxx
Fax:   (xxx) xxx-xxxx

  Reference 3
Company Name:
Contact:
Address:
City:
State:
Postal Code:
Phone:   (xxx) xxx-xxxx
Fax:   (xxx) xxx-xxxx

How did you hear about SJE-Rhombus?

Please make a selection.

I hereby certify that all information provided is true and authorize SJE-Rhombus, CSI Controls, Primex, and/or ICS Healy-Ruff, to contact trade and bank references for normal credit information. The information being furnished to SJE-Rhombus, CSI Controls, Primex, and/or ICS Healy-Ruff is for the purpose of extension of credit. The undersigned authorizes the above listed references to provide SJE-Rhombus, CSI Controls, Primex, and/or ICS Healy­Ruff with information regarding account history. This authorization may include, but is not limited to, obtaining a credit report.

A service charge of 1 Y, % per month may be incurred on all bills remaining unpaid after 30 days past agreed upon credit terms. If this account is placed in the office of a collection agency or attorney for collections, the undersigned shall pay an amount equal to 25% of the unpaid principal and interest as a collection fee, the amount of which the undersigned agrees is reasonable. This is to certify that I am a principal in the above business and in consideration for the extension of credit; I do personally guarantee payment of any and all invoices which remain unpaid for a period of thirty (30) days or longer past agreed upon credit terms. This applies to the above business, and/or company, and/or all affiliate companies, and/or successor companies.


Type Your Full Name: A value is required.
Type Your Title: A value is required.
Today's Date: A value is required.Invalid format. mm/dd/yy

Please make a selection.

I hereby certify that I am an Autorhized Representative and have the Authority to submit this credit application request.

Security Verification: security code
   

 

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