Credit Application

If youprefer you can download the Microsoft Word or PDF version for submission.
NET 30 TERMS - Your submittal of this application implies your acknowledgement and acceptance of the Net 30 invoice terms.
Business Trade Name*
Business Legal Name*
Business Phone*
Business Fax*
Billing Address*
Suite, Unit #
City*
State/Province/Region*
Zip/Postal Code*
Country*
Accounts Payable Information
(who to email invoices/question past due invoices)
Accounts Payable Contact*
Accounts Payable Email*
Accounts Payable Phone #*
Length of time operating the above named business:*
Length of time at the above address:*
Number of Employees*
Annual Sales Income*
Credit Line Desired*
Reseller*
- Yes
- No
Sales Tax Information
If no tax, please attach tax exempt certificate.
D & B #
Federal Tax ID# (TIN)
Attach tax exempt certificate [jpg, png, or pdf (version 7 or later)]
Drop files here or
Banking Information
Bank Name*
Bank Address*
Suite, Unit #
City*
State/Province/Region*
Zip/Postal Code*
Country*
Checking Account #*
Savings Account #*
Loan #*
Account Officer*
Account Officer Phone #
Account Officer Fax #
Account Officer Email
Credit References
Creditor 1*
Contact*
Phone*
Fax*
Email Address
Acct #*
Creditor 2*
Contact*
Phone*
Fax*
Email Address
Acct #*
Creditor 3*
Contact*
Phone*
Fax*
Email Address
Acct #*
Creditor 4*
Contact*
Phone*
Fax*
Email Address
Acct #*
Conditions
We authorize BCDVideo, Inc. to place orders only after receipt of our hard copy purchase orders and/or from signed quotes and we will pay for those orders as invoiced.
Your submittal of this application implies your acknowledgement and acceptance of the Net 30 invoice terms.
Signature*
Title*
Release of Credit Information
The customer for the purpose of obtaining credit submits this information sheet to BCDVideo, Inc. By signing this document the customer certifies that all information is correct to the best of the customer's knowledge. The customer hereby authorizes the release of credit and banking information to BCDVideo, Inc. by the references listed on these pages. Must be signed by authorized person on bank account.
Signature*
Title*
Company represented*
Date*
Captcha

Credit Application

Credit Application

Accounts Payable Information

Sales Tax Information

Banking Information

Credit References

Conditions

Release of Credit Information

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