CREDIT APPLICATION
Company Name*:
Primus Account #*:
Parent Company*:
Principal's Name*:
Billing Address*:
City*:
ST*:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip*:
Phone*:
Fax*:
Type of Business*:
Shipping Address*:
City*:
ST:*
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip*:
D&B #*:
Accounts Payable Contact*:
Phone*:
Email*:
Tax Exemption, Resale, or
Direct Pay # (must include copy of certificate)*:
FEIN*:
Type of Organization*:
Corporation
Partnership
Sole Proprietorship
Limited Liability
Corporation
Date Business Established*:
In
the State of*:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
TRADE REFERENCES
Must include at
least one trade reference
Company Name*:
Account #:*
City*:
ST*:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip*:
Contact:*
Phone*:
Fax*:
Company Name:
Account #:
City:
ST:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Contact:
Phone:
Fax:
Company Name:
Account #:
City:
ST:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Contact:
Phone:
Fax:
Company Name:
Account #:
City:
ST:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Contact:
Phone:
Fax:
BANK REFERENCE
Bank Name*:
Account #*:
Street Address*:
City*:
ST*:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip*:
Contact*:
Phone*:
Fax*:
*PLEASE UPLOAD A COPY OF
THE MOST RECENT FINANCIAL STATEMENT (CERTIFIED, AUDITED
STATEMENTS PREFERRED)
*
Terms Requested*:
Credit Line Requested*:
OPEN ACCOUNT AGREEMENT:
Open Credit Account Agreement: By signing, using, or
requesting issuance of open credit by PRIMUS ELECTRONICS
CORPORATION you agree as follows:
USE OF ACCOUNT: Account
holder will be responsible for all credit extended by PRIMUS
ELECTRONICS CORPORATION in connection with this open credit
account. The account holder will pay to PRIMUS ELECTRONICS
CORPORATION at the address designated on the invoice, all drafts
and obligations evidencing the credit and all extensions thereof
and all service charges, when imposed, in full within the time
and at the terms provided therein.
ACCOUNT HOLDERS
RESPONSIBILITY: Account holder agrees to pay a service
charge on delinquent accounts in the amount of 0.5% per month
and agrees to be responsible for and to pay all products sold to
account older on Net Thirty Terms unless otherwise agreed to in
writing or as invoiced. PRIMUS ELECTRONICS CORPORATION may
revoke account holder's credit and reserves the right to close
this account whenever they deem necessary.
AUTHORIZATION: Account
holder understands and agrees to permit PRIMUS ELECTRONICS
CORPORATION to conduct and investigate report and to obtain
information regarding account holder's credit. Account
holder hereby authorizes PRIMUS ELECTRONICS CORPORATION to
contact third parties to obtain financial information regarding
the account holder's credit capacity, general credit reputation,
character and such other and further information as PRIMUS
ELECTRONICS CORPORATION may deem necessary.
DEFAULT: Payment is to
be made in full on invoices issues by PRIMUS ELECTRONICS
CORPORATION. On any default or failure to pay, it is agreed that
the account holder will pay a finance charge at a periodic 0.5%
per month/annual percentage rate of 6% applied to the "previous
unpaid balance." If not paid in full, PRIMUS ELECTRONICS
CORPORATION may declare any unpaid balances immediately due and
payable. In addition, account holder agrees to pay all costs of
collection including but not limited to the prejudgment
interest, attorney's fees, and court costs.
ENFORCEMENT: This
agreement is binding on the account holder, the account holder's
heirs if any, representatives, successors in interest, and
assigns.
By checking this box, you agree to all of the terms mentioned
above.
BLANKET CERTIFICATE OF
RESALE
This is to certify that all
services, materials, merchandise or goods purchased by the
undersigned from Primus Electronics Corporation after
were purchased for the following reasons:
Resale
or rental as tangible personal property
Resale
as service
To
be incorporated as a material or part of other tangible personal
property to be produced for sale by manufacturing,
assembling,
processing, or refining
Other:
In the event any such property
is used for any purpose other than retention, demonstration or
display while holding it for sale in the regular course of
business, it is understood that I am required by the Sales and
Use Tax Law to report and pay tax, measured by the purchase
price of such property or authorized amount. Description of the
property to be purchased:
Company Name:
Account #:
Address:
City:
ST:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
MN
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Country:
--Select Country--
United States
Albania
Andora
Antigua and Barbuda
Argentina
Aruba
Australia
Austria
Bahamas
Bahrain
Barbados
Belarus
Belgium
Bermuda
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Cambodia
Canada
Canary Islands
Cayman Islands
Chile
China
Colombia
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
England
Estonia
Ethiopia
Fiji
Finland
France
Federated States of Micronesia
Georgia
Germany
Great Britain
Greece
Greenland
Grenada
Guam
Guatemala
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Laos
Latvia
Lebanon
Lithuania
Luxembourg
Macedonia
Malaysia
Malta
Marana Islands
Martinique
Mexico
Monaco
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Reunion
Romania
Russia
Saudi Arabia
Scotland
Senegal
Serbia and Montenegro
Singapore
Slovakia
Slovenia
South Africa
South Korea
Spain
Sri Lanka
St. Kitts and Nevis
St. Lucia
St. Vincent and Grenadines
Sweden
Switzerland
Taiwan
Thailand
Trinidad and Tobago
Turkey
United Arab Emirates
Ukraine
United Kingdom
Uruguay
US Virgin Islands
Uzbekistan
Venezuela
Vietnam
Yugoslavia
Suriname
Qatar
Purchaser's Certificate
Registration #:
Expiration
Date of Certificate (if applicable):