Roca
Printed Circuits
12830 Century Drive - Stafford, Texas 77477
PH: 281-240-8140 FAX: 281-240-0557
Email: sales@rocaprintedcircuits.com
If
you have a standard credit application whose contents are substantially
the same as the form below, it may be
substituted. Please fax the application to:
(281) 240-0557. Otherwise, please fill out the form below and submit
it.
|
| Credit
Application |
Official Company Name*
|
Email Address*
|
Company Mailing Address*
|
Company Street Address (if
different)
|
City*
|
State, Zip*
,
|
Company Phone*
|
FAX Number
|
Accounts Payable Contact
|
|
Company Structure
|
If other Company Structure, please
list
|
Name of Company President
|
Federal ID Number
|
D & B Number
|
|
| Banking
Information |
Account Number
|
Bank Contact
|
Bank Address
|
|
City
|
State, Zip
,
|
Bank Phone Number
|
Bank FAX Number
|
| Trade
References |
Reference 1Company Name
|
Contact
|
Reference 1Company Address
|
|
City
|
State, Zip
,
|
Reference 1 Phone Number
|
Reference 1 FAX Number
|
Reference 2 Company Name
|
Contact
|
Reference 2Company Address
|
|
City
|
State, Zip
,
|
Reference 2 Phone Number
|
Reference 2 FAX Number
|
| |
|
Reference 3 Company Name
|
Contact
|
Reference 3 Company Address
|
|
City
|
State, Zip
,
|
Reference 3 Phone Number
|
Reference 3 FAX Number
|
| |
|
|
|
