QUALITY CABLE & ELECTRONICS, INC.

 

6750 N. Andrews Ave., Suite 200

Ft. Lauderdale, Florida 33309

Tel: (954) 978-8845 

  Web: www.qualitycable.com    Email:  Sales@qce.cc

 

 

CREDIT APPLICATION

 

COMPANY NAME: ___________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY ____________________________________________ STATE: ____________ ZIP: _________ ___________

PHONE: _____________________________________     FAX: _________________________

 

CREDIT LIMIT REQUESTED - $___________________

 

IN BUSINESS SINCE? MONTH: _______ YEAR: _____

 

DUN & BRAD STREET RATED?  Y_______ / N_______     RATING: ____________________________

 

HAS THIS BUSINESS OR ANY MAJORITY OWNER DEFAULTED ON ANY LOANS, DECLARED CHAPTER 11, OR BANKRUPTCY?  Y_____ / N_______

(IF YES PLEASE ATTACH A SEPARATE SHEET OF PAPER WITH FULL EXPLANATION)

 

BANK REFERENCES

 

PRIMARY BANK: ____________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY: __________________________________ STATE: _______________ ZIP: _________________

PHONE: ________________________________      FAX: ____________________________________

ACCOUNTT#: _____________________________ AVERAGE MONTHLY BALANCE: $__)__________

CONTACT: _________________________________________________________________________

 

SECOND BANK (IF APPLICABLE):  NAME: _______________________________________________

CITY: __________________________________ STATE: _______________ ZIP: _________________

PHONE: __________________________________  FAX: ____________________________________

CONTACT: ________________________________ ACCOUNT#: _____________________________

 

TRADE REFERENCES (WITHIN THE COMMUNICATION INDUSTRY)

 

1) COMPANY NAME: _________________________________________________________________

     ADDRESS: _______________________________________________________________________

     PHONE: ________________________________  FAX: ____________________________________

     CONTACT: _______________________________________________________________________

 

2) COMPANY NAME: _________________________________________________________________

     ADDRESS: _______________________________________________________________________

     PHONE: ________________________________  FAX: ____________________________________

     CONTACT: _______________________________________________________________________

 

3) COMPANY NAME: _________________________________________________________________

     ADDRESS: _______________________________________________________________________

     PHONE: ________________________________  FAX: ____________________________________

     CONTACT: _______________________________________________________________________

 

NAME OF OFFICER (PRINT): __________________________________    DATE: _________________

SIGNATURE: _______________________________________________________________________

 

(HARD COPY NEEDED (NOT FAX) FOR FINAL APPROVAL)

*INTERNATIONAL CLIENTS PLEASE FAX REQUEST FOR A SPECIAL APPLICATION*