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Florida Bearings

Florida Bearings

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Online Credit Application

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* Required Field

* Company Name

* Mail to Address

Mail to Address (continued)

* City

* State

* Zip

Ship to Address (Only if Different than Mail to Address)

Ship to Address (continued)

City

State

Zip

*Phone Number

Fax Number

*E-mail Address

* Business is owned

* Nature of Business

* Owner, Partner, Officer Name	* Title

Credit References with whom you have established OPEN ACCOUNTS
* Company Name	Fax Number	* Phone Number

* Person Authorized	* Title

Purchase Order Number Required YES NO

Federal ID#

Taxable YES NO
(If no, please fax a copy of your Tax Certificate to 305-573-2410)

* Accounts Payable Contact

* Phone Number

Fax Number

BY SUBMITTING THIS APPLICATION YOU AGREE TO THE FOLLOWING:
Unpaid balances over 30 days from the invoice date will be accessed 1.5% interest per month. Florida Bearings aggressively pursues collections of it's overdue accounts receivable, any invoice(s) which require legal assistance for collection will be subject to reasonable attorney's fees in addition to the above referenced interest.

* I agree

* Signature Name

* Title

* Date Month/Day/Year

Comments

* Verification Code

Verification Code

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