CREDIT APPLICATION

Please complete the Credit Application.

* indicates required field

CUSTOMER INFORMATION
COMPANY NAME:*
BILLING ADDRESS:
SHIP TO ADDRESS:
PHONE:*
FAX:
FEIN/SSN #:
ACCOUNTS PAYABLE:
NAME
PHONE
EMAIL ADDRESS
ARE YOU TAX EXEMPT:
DO YOU HAVE A MAQUILADORA ID:
*IF YOU ARE TAX EXEMPT OR HAVE A MAQUILADORA ID, WE REQUIRE A COPY OF YOUR TAX EXEMPTION FORM OR MAQUILA CERTIFICATE.
Max. file size: 1,000 MB.
DO YOU REQUIRE PURCHASE ORDERS:
**YOU CAN ALSO UPLOAD YOUR COMPANY CREDIT INFORMATION.
Max. file size: 1,000 MB.
REFERENCES
**PLEASE PROVIDE THREE (3) CREDIT REFERENCES: THESE ARE REQUIRED TO BE BUSINESS ACCOUNTS WITH WHOM YOU HAVE CONDUCTED BUSINESS IN THE LAST 6 MONTHS.
1) Name/Location
Phone/Email Address
2) Name/Location
Phone/Email Address
3) Name/Location
Phone/Email Address
TERMS AND CONDITIONS
Medley default net terms are net10 days, which we will extend terms upon credit approval. If any invoices should fall past due, we understand that there will be late fees and service charges applied that we will be responsible for. A $25.00 fee is charged on all return checks. Any service or billing issues should be sent to Medley Material Handling Company within 30 days of the original invoice date. We understand that all property and material belonging to Medley Material Handling Company remains. We authorize the vendors to release the necessary credit information to Medley Material Handling Company. I agree to the above terms:
By checking this box you are giving your digital signature.*
- Check for signature
Title*
Printed Name*
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

CREDIT APPLICATION

Please complete the Credit Application.

* indicates required field

CUSTOMER INFORMATION

ACCOUNTS PAYABLE:

REFERENCES

TERMS AND CONDITIONS