The Interconnect Co. Inc. - Credit Application

Credit Application

Business Contact Information

Title

Company Name:

Phone:

Fax:

E-mail:

Registered company address:

City:

State:

ZIP:

Date business commenced:

Sole proprietorship:

Partnership:

Corporation:

Other:

Business and Credit Information

Primary business address:

City:

State:

ZIP:

TAX ID No.

D&B No.

Telephone:

Fax:

E-mail:

Bank name:

Bank address:

City:

State:

ZIP:

Phone:

Type of account:

Account number:

Savings:

Checking:

Other:

Trade References

Company Name:

Contact:

Address

City:

State:

ZIP:

Phone:

Fax:

E-mail:

Type of account:

Company Name:

Contact:

Address

City:

State:

ZIP:

Phone:

Fax:

E-mail:

Type of account:

Company Name:

Contact:

Address

City:

State:

ZIP:

Phone:

Fax:

E-mail:

Type of account:

Agreement

By submitting this application you authorize the INTERCONNECT CO., INC. to make enquiries to the banking, savings, business, and/or trade references you have supplied.

Signatures

X___________________________________ X______________________________________

Authorized Representative Signature

Print Name

All repairs not claimed after 30 days will remain the property of THE INTERCONNECT CO., INC.
Default: If the Customer fails to make payment when due payable. The Interconnect Co., Inc. shall have the right to exercise any one or more of the following remedies. To bring legal action for and recover all payments and other amounts due, then occurred or thereafter occurring, with respect to any or all items of equipment. To take possession of any or all items of equipment, whenever the same shall be located, without any court order or other process of law. The Customer hereby waives any and all damages occasioned by such taking of possession. To pursue any other remedy at law or in equity. To cease to perform maintenance until such time as the default is cured. There will be a $35.00 service charge on all returned checks.