Credit Application

Please complete the credit application below, and we will follow up with you shortly. If you have any questions, call (877) 722-6784 or contact us for more information.

Company Profile
Company Name*
Address
Street Address City State ZIP Code
Phone
Fax
Please check one:*
- Proprietorship
- Partnership
- Corporation
Name and Home Address of Proprietor or Partners
Name
Title
Social Security #:
Address
Street Address City State ZIP Code
Name
Title
Social Security #:
Address
Street Address City State ZIP Code
If Corporation, Officer's Names
President
Buyer
Payables
Date Established
How long at present address
Number of Employees
Resale Number
Dun & Bradstreet Number
Trade References
Trade Reference Name
Address
Street Address City State ZIP Code
Trade Reference Name
Address
Street Address City State ZIP Code
Trade Reference Name
Address
Street Address City State ZIP Code
Trade Reference Name
Address
Street Address City State ZIP Code
Bank References
Name
Address
Street Address City State ZIP Code
Type of Account
- Checking
- Savings
Account Number
Approval and Submission
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*
Date
Print Name
Title

Call Us Toll-Free:
877-722-6784
info@scantec.com

Credit Application

Company Profile

Name and Home Address of Proprietor or Partners

If Corporation, Officer's Names

Trade References

Bank References

Approval and Submission

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