Credit Application:

Name of Business:

Nature of Business:

Name of Principal Owner and Title:

Federal I.D. #:

Seller’s Permit No.:

Please Choose One: Reseller End User

Please Choose One:
(If Non-Taxable, please forward tax exempt certificate.)

Taxable
Non-Taxable

Form of Ownership: Corporation Partnership Sole Proprietor

Date of Incorporation:

Years in Business:

Parent Company (if subsidiary):

Dun & Bradstreet:

Gross Revenue (Annual):

No. of Employees:

Billing Information:

Bill to Name:

Street/P.O. Box:

City:

State:

Zip Code:

Country:

Contact Person:

Phone No.:

Fax No.:

E-mail Address:

Shipping Address if Different:

Freight terms – our freight terms are prepaid and add unless you provide your third party billing information:

Bank Reference

Bank Name:

City:

State:

Account Number(s):

Phone Number:

Fax Number:

Trade References

Terms and Conditions

Zeller Corporation’s credit terms are strictly Net 30 days. An account shall be considered past due if unpaid after 30 days from date of invoice. Once an invoice becomes 30 days old, a finance charge of 1.5% per month may be applied to the unpaid balance.

In the event that a past due amount is referred for collection to an agency or attorney, the undersigned will pay all cost of collection, including attorneys’ fees, whether or not action is commenced or pursued to judgment.

It is understood that Zeller Corporation will rely upon representations made by the undersigned in this application.

Check Here if you agree to the above Terms and Conditions.