Credit Application:

CREDIT APPLICATION
Please FAX This Form To:               

MOORE'S ELECTRONICS            
548 Virginia Drive
Tiburon, CA 94920
Phone: 415-435-3712
FAX: 415-435-4873                        

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Company Name

Address

Telephone

Fax

DUNS No.

Dun & Bradstreet Rating

Company ID

Federal ID No.

Social Security No.

Parent Company (if applicable)

Type of  Business

Partnership

Proprietorship

Corporation

If Corporation

State Incorporated In

Year

Years in Business Under Above Name & Ownership

BANK REFERENCE:

Name
Address
City, State & ZIP
Account #			Telephone		Contact

TRADE REFERENCES:

1. Name		Telephone
Address

 

2. Name		Telephone
Address

 

3. Name		Telephone
Address

PROPRIETOR, PARTNERS, OR OFFICERS:

1. Name		Title
2. Name		Title
3. Name		Title

  In the last seven years, has the above company had judgments, liens, and/or lawsuits against the company?

Yes

No

  If yes, please provide details on separate sheet.

  Purchases Are For Resale:

Yes

No

  If yes, please attach a valid Certificate of Resale.

 Customer Is Direct Pay:

Yes

No

  If yes, please attach copy of Tax Exempt Certificate.

  MOORE'S Credit Terms:      Net 30 Days  

  Shipping Terms:         FOB Shipping Point (Prepay and add to invoice)

AGREEMENT:
If applicable, Customer agrees to provide a valid Certificate of Resale or Direct Pay Certificate if purchases are non-taxable for sales tax purposes.  In addition, if customer fails to make payment as agreed, interest shall begin to accrue on any unpaid balance as of the due date at an annual rate of 9.5% and shall continue to accrue until paid in full.  In addition, Customer agrees to pay reasonable legal expenses and attorneys’ fees incurred by Moore's Electronics in collecting monies owed to this account in the event of default.

Printed Name		Title
Signature		Date

MOORE'S ELECTRONICS, 1102 Waterford Way, Lodi, CA  95242, Tel: 209.369.3963, Fax: 209.369.3945

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