Credit Application

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Credit Application
Fields marked with an * are required

Company Information

Mailing Address

Shipping Address

Contact Information

Company Profile

Officers or Principals

Accounts Payable

Credit References

Please Confirm:

I certify that I am authorized by my employer to apply for open account terms and the information provided in the application is true and correct. I am agreeing to comply with all terms of open accounts as set forth by Ten-Four Communications who also reserves the right to change terms at any time, without notice. I understand that Ten-Four Communications reserves the right to begin charging 1.5% per month on all outstanding balances past due. I hereby authorize the release of credit information requested relevant to the above account for the attainment of a credit report from a credit reporting agency. I understand that application for terms in no way constitutes approval by Ten-Four Communications.