APPLICATION FOR CREDIT – Terms Are Net 30 Days, OAC Credit,
User Manual: Application For Credit, Net 30
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www.anaheimautomation.com
910 East Orangefair Lane Anaheim, CA 92801 714-992-6990 714-992-0471, Fax
APPLICATION FOR CREDIT – Terms are Net 30 Days, OAC
Company
or
Individual
Applying
for Credit
Name:__________________________________________________
Division:_________________________________________________
Physical Address:__________________________________________
City/State/Zip:____________________________________________
Phone: ( )________________________Ext._____________
Fax: ( )____________________________
Purchasing Contact:_________________________________________
Billing Address:_____________________________________________
City/State/Zip:______________________________________________
Phone: ( )__________________Fax: ( )_________________
Date:______/______/__________
Year Established:____________
Years at this address:________
(If less than 2 years, please provide previous
address on separate page)
Web site:____________________
@__________________________
Accounts Payable Contact:
Phone: ( )_______________
Email:_______________________
@__________________________
Classification:
___Individual
___Partnership
___Corporation
___Government
_
__AA Distributor
_
__Sole
Proprietorship
Please Provide Pertinent Company Information below:
(Held strictly confidential)
Business Credit References: (Please provide at least two
businesses, including phone, fax and contact name)
Resale: _____No _____Yes
Resale#
NOTE: A Signed CA Resale Certification is
required for our files.
D&B #
________________________
Vendor #
(If assigned by your company)
_______________________
Please Note:
Typical
Processing Time
for Credit
Applications
is 48 hours.
Bank Information:
Bank Name:____________________________________ Account#:____________________________
Address:__________________________________ City/State/Zip:_____________________________
Fax: ( )_____________________________ Fax: ( ) _____________________________
VERIFICATION:
(Do not fill out this box)
___Checked Bank
___Checked D&B
___Checked References
___CREDIT APPROVED
___CREDIT DENIED
I certify that the information herein is true and correct.
I fully understand that Anaheim Automation’s Terms are
strictly Net 30 Days.
___Agree to comply to Terms
Print Name:
______________________________________________________________
Signature:__________________________________
Date: ______________
RETURN BY FAX:
(714) 992-0471
or
Mail to address
listed below
Attn: Accts. Rec.
