Transales Customer Application

Business Name:(Required)

DBA:(Required)

Fed. Tax ID #(Required)

Phone:(Required)

Fax:(Required)

Billing address:(Required)

City:(Required)

State:(Required)

Zip(Required)

Type of Business:(Required)

Years at Address:(Required)

Previous address (if applicable):

Year Company Established:(Required)

Years in Business:(Required)

Please enter a number less than or equal to 200.

ACCOUNT PAYABLE INFORMATION

Billing Contact:(Required)

Phone:(Required)

E-Mail:(Required)

Invoice Email(Required)

TRADE REFERENCES

Company:(Required)

Address:(Required)

Contact Person:(Required)

Phone:(Required)

Email:(Required)

Company:

Address:

Contact Person:

Phone:

Email:

Company:

Address:

Contact Person:

Phone:

Email:

I (We) affirm that the facts and statements provided in this application are accurate and representative of my (our) affairs as of this date. By signing this application, I (We) hereby authorize Transales, Inc. to contact the credit references, and other source s, to investigate my (our) credit standing. If credit is approved, I 0Ne) agree to pay in accordance with your terms. I (We) understand that all invoices are due and payable within 7 days following the invoice date and that a service charge of 1.5% per mon th may be assessed on all invoices not paid. I (We) understand that any allowed discounts will be cancelled is payment is not made according to terms. In the event Transales, Inc. is assessed for costs incurred in the collection process, including attorney fees.

Signature of applicant:(Required)

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