Aztalan Engineering, Inc. : : Contact: Credit Application

CREDIT APPLICATION Please complete this online form in it's entirety and submit for review or click here for a printable version.
	Legal Company Name:*
	Application Completed By:
	A/P Contact:
	Owner/Corporate Officer:
Billing Address:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Phone:*
	Fax:


Shipping Address:

		Same as Billing Address
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Phone:*
	Fax:

Corporate Headquarters:
	Corporation Partnership Proprietorship Private
	Years in Business:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Phone:*
	Fax:
	Tax ID:
	DUNS #:
	Primary NAICS:
	Ever Filed Bankruptcy:	YesNo
		If yes, what year?
	Names of Corporate Officers or Partners:





	Bank References:
	Bank Name:
	Bank Account #:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Contact:
	Phone:*
	Fax:

	Bank Name:
	Bank Account #:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Contact:
	Phone:*
	Fax:
	Business References:
	Last Name:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Phone:*
	Fax:

	Last Name:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Phone:*
	Fax:

	Last Name:
	Address:
	Address:
	City:
	State/Providence:
	Zip/Postal Code:
	Phone:*
	Fax:

	The above information is for the purpose of obtaining credit and is warranted to be true. Aztalan Engineering, Inc. is authorized to investigate these references. Applicant agrees to pay all invoices within thirty (30) days of delivery of the goods. Applicant also agrees to pay finance charges at 1.5% per month on outstanding balances. Delinquent accounts automatically revert to cash on delivery (C.O.D.).

	Please add me to your email list

Website Developed By: Caught In The Web, LLC