Recon Services

Credit Application

Who is your sales representative?

Legal Business Name

Date

Month

Day

Year

Business Address

Phone/Fax

Years in Business

Federal ID or SSN

Estimated Monthy Purchases (USD)

Business Description (activity generally engaged in)

Sales Tax Status

Taxable

Tax Exempt (certificate required)

Structure

Sole Proprietor

Partnership

Corporation

Operations Contact

Name

Phone

Accounting/AP Contact

Name

Phone

Email for receiving invoices

Principal One

Name

Title

Resident Address

Principal Two

Name

Title

Resident Address

Principal Three

Name

Title

Resident Address

Banking Information

Bank Name

Bank Account Number

Trade Reference One

Company Name

Contact

Phone

Trade Reference Two

Company Name

Contact

Phone

Trade Reference Three

Company Name

Contact

Phone

Terms & Conditions

Applicant hereby agrees to the following terms & conditions

Payment terms are "Due on Receipt"
Monthly, a 1.5% finance charge will be assessed on balances older than 30 days
Slow payment may result in account closure or conversion to COD
In the event of a default, applicant will be responsible for all collection and court costs
A deposit may be required to establish the account

Signature

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