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Online Credit Application

Click Here for Printable Version

* Required Field

* Company Name

* Mail to Address

Mail to Address (continued)

* City

* State

* Zip


Ship to Address (Only if Different than Mail to Address)

Ship to Address (continued)

City

State

Zip


*Phone Number

Fax Number

*E-mail Address


* Business is owned

* Nature of Business

* Owner, Partner, Officer Name * Title





Credit References with whom you have established OPEN ACCOUNTS
* Company Name Fax Number * Phone Number













* Person Authorized * Title





Purchase Order Number Required YES NO Federal ID#
Taxable YES NO
(If no, please fax a copy of your Tax Certificate to 305-573-2410)


* Accounts Payable Contact

* Phone Number

Fax Number

BY SUBMITTING THIS APPLICATION YOU AGREE TO THE FOLLOWING:
Unpaid balances over 30 days from the invoice date will be accessed 1.5% interest per month. Florida Bearings aggressively pursues collections of it's overdue accounts receivable, any invoice(s) which require legal assistance for collection will be subject to reasonable attorney's fees in addition to the above referenced interest.
* I agree

* Signature Name

* Title

* Date     Month/Day/Year


Comments

* Verification Code
Verification Code

Enter the black characters found in the above image.

           

 

 

 
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