Totalcomp Scales & Components - Large Wholesale Scale & Balance Distributor

Credit Application

Application for Credit Form

This form is intended only for Scale Dealers, OEM and Scales Service Companies.
End users will be discarded or re-directed to a distributor in their area.

* Required information

Company Information*

Company Name:

Contact Name:

Street Address:

City:

State/Province:

Zip Code:

Country:

Phone:

Fax:

E-Mail:

Years in Business:

Business Status*

Type of Business*

Corporation

Manufacturer

Dealer

Individual

Service

Name of Officers, Owner or Partners*

President:

Vice President:

Secretary:

Treasurer:

Owners:

Partner:

Bank Reference*

Bank Name:

Street Address:

City:

State/Province:

Zip Code:

Country:

Bank Phone:

Bank Fax:

Account Number:

Business References*

At least one reference must be given

Reference 1*

Reference 2

Reference 3

Full Name:

Street Address:

City:

State/Province:

Zip Code:

Country:

Phone:

Fax:

Full Name:

Street Address:

City:

State/Province:

Zip Code:

Country:

Phone:

Fax:

Full Name:

Street Address:

City:

State/Province:

Zip Code:

Country:

Phone:

Fax:

Tax Exempt Number:

*Note: Terms are Net 30 days, 1.5% per month finance Charge on unpaid balance after 30 days. 18% annual rate. If account is sent to a collection agency, a 25% service charge for collection will be added.

I Agree (type your name)

Title:

Date:

Enter Validation Code To Continue

To prevent spamming, please
enter in the letters in the box.