Credit Application

Your Name:

Company Name:

Street Address:

City, State, Zip:

Phone Number:

Your Email:

Type of Business:

Fax Number:

Length of Time In Business:

Tax Exempt Number:

Proprietorship:

Partnership:

Corporation:

Federal ID Number:

Name of Owners of Officers:

Title:

Name and Phone Number for three (3) Trade References:

Bank Reference: Name, Address & Fax Number

Account Number, Contact & Phone Number:

It is understood that this application is subject to approval by the Credit Department of Automation Aids, Inc. Should such circumstances prevent extension of credit at any time, we agree to accept cash or COD terms. We further agree to comply with the credit terms established by Automation Aids, Inc.

Authorized Signature

Date

All information shall be treated as confidential. Our main purpose in requesting this information is to accomplish a closer working relationship with our customers and a working agreement that will be to our mutual benefit.

Credit Application

CREDIT APPLICATION

All information shall be treated as confidential. Our main purpose in requesting this information is to accomplish a closer working relationship with our customers and a working agreement that will be to our mutual benefit.

About AAI

Automation Aids, Inc.