N93 W14636 Whittaker Way
Menomonee Falls, WI 53051
Toll Free : 800-242-2090
Local : 262-251-5511
Fax : 262-251-4737
medmgt@computersupplypeople.com
Home Our Company Products Services Customer Center
Credit Application Phone: 800-242-2090 Fax: 262.251.4737
The undersigned company is applying for credit with Media Management & Magnetics, N93 W14636 Whittaker Way, Menomonee Falls WI, 53051 and agrees to the terms and conditions listed on Page 2 of this document.
*First Name
*Last Name
*Email Address
Company
DBA (if different)
Contact person
Address
Phone
Fax
Federal tax ID or Social Security number.
Type of business
No. of employees
Date business established
Types of products you will purchase
Amount of credit requested $
Are you a:
CORPORATION
State of incorporation
Names, titles, and addresses of your three chief corporate officers
Name and address of your resident agent
PARTNERSHIP
Names and addresses of the partners
SOLE PROPRIETORSHIP
Have you ever declared Bankruptcy?
Yes
No
If Yes, when
Are you Sales Tax exempt?
Yes
No
If Yes, please send a copy of Certificate.
Have you ever had credit with us before?
Yes
No
If yes, under what name?
Authorized purchasers:
Credit Manager:
Purchase order required?
Yes
No
TRADE REFERENCES
Reference #1
Name
Address
Phone
Reference #2
Name
Address
Phone
Reference #3
Name
Address
Phone
BANK REFERENCES
Bank#1
Account #
Phone
Contact person
Name of bank
Address
Bank#2
Account #
Phone
Contact person
Name of bank
Address
I represent that the above information is true and is given to induce to extend credit to the applicant.
My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports.
My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.
I have read the terms and conditions stated below and agree to all of these terms and conditions.
Authorized signature:
Printed name:
Date:
Title:

*Required Fields
GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE
  • 1. All bills become payable in full, Net 10. After 10 days, they are considered past due.
  • 2. A service charge of 2% per month will be added to all delinquent accounts past 30 days.
  • 3. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.
  • 4. PERSONAL GUARANTEE: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.
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