Phone: 415/330-9881 Fax: 415/330-9900 Email: info@horizonsia.com
APPLICATION
FOR CREDIT
All
information will be kept confidential.
Company Name:
Address:
City:
State: Zip:
Phone: Fax:
Type of Business:___ Sole Proprietorship___ Partnership___ Corporation
Years in Business:
Is your firm rated w/
Credit References: Please
supply us with eight of your present suppliers.
Please include a fax number.
1)Name: Account #
Address:
City:
State: Zip:
Phone:
Fax:
2)Name:
Account #
Address:
City:
State: Zip:
Phone:
Fax:
3)Name:
Account #
Address:
City:
State: Zip:
Phone:
Fax:
4)Name:
Account #
Address:
City:
State: Zip:
Phone: Fax:
5)Name:
Account #
Address:
City:
State: Zip:
Phone: Fax:
6)Name:
Account #
Address:
City:
State: Zip:
Phone:
Fax:
The undersigned acknowledges and agrees
to Horizons Credit terms (please see the following), Including
payment within 30 days of invoice date. Interest of 1.5% per month, collection
charges ad legal fees wil be charged to past due
accounts.
Name:
____________________________________
Title:
_____________________________________
Signature:
_________________________________________
Date:
____________________________________________