Page 2 - Window Doctor Parts Catalog
P. 2

CREDIT APPLICATION
                                                     (please print)
     Billing     Name                                       Phone                        Fax
     Information
                 Company                                                                 E-mail

                 Street
                 City                                       State                        Zip


     Ship To     Name
     Information
     (if different   Company                                                     Commercial    Residential
     from above)
                 Street

                 City                                       State                        Zip

     Ownership    Individual     Partnership       Corporation    Other, explain ___________________________________

                 Principals

                 Name                                       Address                      City, State, Zip
                 Federal I.D. Number

                 Years in Business

     Customer    1.  PO required?           yes   no           4.  Require fax or email
     Special     2.  Monthly statements?    yes   no              acknowledgments on all orders.   yes   no
     Conditions     If yes, do you want:    Email    Fax    Mail  5.  Print your part # on packing slip?   yes   no
     (circle your      If no, you will only receive invoice. How do you want to   6.  Designate orders to:
     choice)        receive your invoice?   Email    Fax    Mail     a.  ship complete / no back orders
                 3.  Print prices on packing slip?   yes   no     b.  ship complete unless otherwise specified
                    (not recommended for those                    c.  ship partials / ship back orders complete
                    using our drop ship program)                  d.  ship partials / ship back orders as they come in


     Bank        Bank Name                                  Address
     Reference
                 Type of Account        Account #           Bank Officer’s Name          Phone

     Vendor
     Reference   Company                                    Fax

                 Street                                     Phone                        E-Mail
                 City                                       State                        Zip

                 Company                                    Fax
                 Street                                     Phone                        E-Mail

                 City                                       State                        Zip
                 Company                                    Fax

                 Street                                     Phone                        E-Mail
                 City                                       State                        Zip

     I the undersigned confirm that all information given in this application is true and correct to the best of my knowledge. I understand that terms on all purchases
     are net 30 days. If this application is approved, I recognize that I/we will be responsible for any attorney’s fees and/or costs incurred in the collection of any
     unpaid balance.

                                    Signature                                                Date
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