Steren AP-BNC-6 User Manual
117
Credit Application
Mail to: Steren Electronics International, LLC.
Attention: New Accounts
6260 Sequence Drive, Suite 110
San Diego, California 92121
Tel (800) 266-3333
FAX (800) 266-3334
This information is for the exclusive use of our Credit Department and will be held in the strictest of confidence.
Your current year–end financial statement (balance sheet and income statement) must accompany this application if the
Your current year–end financial statement (balance sheet and income statement) must accompany this application if the
credit line desired exceeds $5000. Unaudited financial statements must be signed and dated by the respective owner or
officer. Please indicate what period is covered by each statement.
California customers exempt from sales tax must submit a signed resale certificate.
California customers exempt from sales tax must submit a signed resale certificate.
Business Legal Name
Business Trade Name (dba) or Previous Name
Business Trade Name (dba) or Previous Name
Tax I.D. No.
Street Address (required)
P.O. Box
City
State
Zip
Telephone
FAX
Description of Primary Business
Number of Employees
Credit Line Desired
Number of Employees
Credit Line Desired
Annual Sales Volume
Legal Structure of the Business
q
Proprietorship
q
Partnership
q
Corporation
State in which chartered
Year Business Established
Length of time at the above address
q
Own
q
Lease
Number of branches/outlets
Square Footage
Have you ever filed for bankruptcy ?
q
No
q
Personal
q
Business
Date Filed
Current Status
Corporate Officers or Principal Owners
Name
Name
Title
Telephone
Name
Title
Telephone
Name
Title
Telephone
Authorization to Run Credit
q
Yes
By Checking Yes you are giving Steren Electronics International LLC. permission to check your credit report.
You MUST check the box before we can process your application.
Name
Name
Home Street Address
Home Street Address
City/State/Zip City/State/Zip
Telephone
Telephone
Telephone
Social Security No.
Social Security No.
Driver Licence No.
Driver Licence No.
Please complete both sides
Important Information
General Information
Business Profile
Personal Credit Information