New open Accounts Credit Application Form
New trade accounts use this form if you are interested in applying for an open
30 day account.
Please print and fill out credit application form and fax it at
360-658-0393
or send as an e-mail attachment to marketing@rajindia.com
as soon as possible .
Date ________________________State Tax No.________________________
Date Business started___________
Full Legal name of company for which credit is requested.
Company Name __________________________________________________________________
Mailing Address __________________________________________________________________
City____________________ State ________ Zip
Code _______________
Shipping Address (if different from above) _____________________________________________
City_____________________ State _________ Zip Code____________________
Business Phone ( _____ ) ______________Fax Phone ( _____ )_________________
e-mail address: ____________________________
URL (if any) http://________________________
Person to Contact ___________________ Phone No. (______ ) ___________________
Buyers Name ________________________Phone No.( ______ ) ___________________
Corporation ____ Sole Proprietorship ____ Partnership_____
State______ Year established________
Trade References ( list below firms from which you have purchased on open accounts
Name____________________________________
Address __________________________________
City_____________________________________
State______ Zip ______ Phone_____________ Fax
____________
Name____________________________________
Address __________________________________
City_____________________________________
State______ Zip ______ Phone_____________ Fax
_____________
Bank References ( please complete information requested for the bank which handles your accounts
Bank Name ______________________________
Address __________________________________
City_____________________________________
State______ Zip ______ Phone_____________ Fax _______________
Account No. ______________________________
We certify that all the information on this form is correct; and that we fully understand your credit
terms
and agree to the proper payment in consideration of extended credit, including any legal fees and court costs
incurred while collecting past due amounts.
Signed by __________________________________
Date __________ Title ______________________
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