99 Scott Avenue
Brooklyn, NY 11237
800-221-3026 Fax 718-366-5359

New Customer Information & Credit Application

Thank you for your interest in our company. If you wish to apply for open account, please print out this form and fax or mail to Acme American Group.

Date
Business Name:
Address
City
State
Zip
Phone
Fax:
 
If Corporation, give date/state of incorp:
Federal ID#
 
Names of Officers Title
Please complete the following:  
Names of Principles
Address of Principles
 
Trade References:  
1. Credit Reference
Address
City
State
Zip
Phone
Fax:
 
2. Credit Reference
Address
City
State
Zip
Phone
Fax:
 
3. Credit Reference
Address
City
State
Zip
Phone
Fax:
How Long Business Established
Yrs./Mos.
 
Application cannot be processed unless this section has been signed.

Please attach a copy of your Resale Certificate for each state in which you are exempt. Unless a copy of your resale certificate is attached, we must treat you as TAXABLE and charge any local, county, and state sales taxes.

I understand and agree that a service charge of 2% per month, but not in excess of the lawful maximum, will be added on any past due amount. In addition, I further understand and agree that if my account becomes significantly past due and is referred to an attorney or collection agency, collection costs will be added to the account.

I authorize the release of financial and credit data by any vendor with whom we do business to Acme American Group. The purpose of this information is to establish open account for the purchase of supplies and will be held in strict confidence.

 
Name of Firm:
Signed by:
Print Name:
Title:
Date: