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Credit Application Lease Application Tax Certificate Warranty Registration Company Profile : Complete Firm Name:   Corporation        Partnership          Other   Dunn & Bradstreet #   Date business established   Phone:  Ship to address:   Ship to county:   Bill to address:   Bill to county:   Accounts payable contact:   Accounts payable contact email:   Phone: Fax: Sales tax applicable ? Yes  No    ( If no, must submit tax exemption cert. ) P.O. required ? Yes  No  Credit line requested ?   The information furnished on this application is warranted to be true and correct to the best of the applicant's knowledge. The applicant hereby authorizes Air Components & Systems Ltd., to investigate any references or information provided pertaining to credit or financial responsibility. Applicant agrees that the use of any credit granted will be subject to the ACS's credit terms and other applicable rules and regulations. Applicant understands and agrees to accept responsibility for payment of all fees in the event of account delinquency.

Principal's Names: Name:   Title: Name:   Title: Name:   Title: Authorized Buyer(s): Name:   Email: Name:   Email: Business/Trade References: Name:   Phone: Name:   Phone: Name:   Phone: Bank Reference: Name:   Phone: Branch:   Contact: Account number:

Terms are net due 15 days from date of invoice, payable in full. No goods are returnable without Air Components & Systems, LTD's approval. Credit privileges will be withdrawn on all past due accounts. A finance charge of 1?% per month is due on all amounts over 90 days past due. I (we) agree to the terms stated above and authorize Air Components & Systems, LTD. to process credit inquiries on references provided for the purpose of establishing credit. Name: (Owner or officer only) Email: Title:   Date application completed:     For PDF/Credit Application Click Here     Questions about this form ? Email Us