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Credit Application
Please fill in the credit reference information in the fields below and press the submit button. Or you can print this document and fax it back completed to 1-352-332-7133. Thank you.

Company Profile:

Company Name:
Address:
City:
State: Zip:
Phone:
Fax:


Please check one:
Proprietorship Partnership Corporation Other:

Name and Home address of Proprietor or Partners:

Name & Title:
Address:
City:
State: Zip:
Social Security #:

Name & Title:
Address:
City:
State: Zip:
Social Security #:


If Corporation, Officer's Names:
President:
Buyer:
Payables:
Date Estd.:
How long at present address:
# Employees:
Resale #:
Dun & Bradstreet Number:

Trade References:

Trade reference name:
Address:
City:
State: Zip:
Credit Limit:

Name:
Address:
City:
State: Zip:
Credit Limit:

Name:
Address:
City:
State: Zip:
Credit Limit:

Name:
Address:
City:
State: Zip:
Credit Limit:

Bank References:

Name:
Address:
City:
State: Zip:


Type and Number of Account:
Checking: #
Savings: #


Customer shall be responsible for all legal and collection fees in regard to this account. No returns allowed without RMA number. No refunds allowed after 15 days from the date of invoice. There will be a $25 charge for any returned checks. 1.5% finance charge will be applied to any invoice which is past due. There will be a $30 diagnosis charge for items returned as defective and test good.

I have fully read the terms & conditions in this catalog and agree to abide by them. I also agree to let Scan Technology obtain any credit information necessary for terms with Scan Technology.

Authorized Signature:
Print Name:
Title:
Date:

Copyright © 1996-2013 Scan Technology, Inc. Product Names and Trademarks belong to their respective owners. All rights reserved.
Scan Technology, Inc. 170 Keele Road, Manchester, TN 37355, Phone: (931) 723-0304 Fax: (931) 723-0208
10305 N.W. 4th Place Gainesville, FL 32607, Phone: (352) 332-2093 Fax: (352) 332-7133
Quantity discounts available upon request. Dealers and VARs are invited to inquire about becoming a Scan Technology, Inc. reseller.