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AC - Credit Application

CREDIT APPLICATION

To apply for credit terms from AlphaCard, please take 5 minutes to fill out the form below. Make sure you fill out all the required fields.

If you have any questions, or if you are located outside of the United States and Canada, please call 800-717-8080.

BUSINESS CONTACT INFORMATION

Email Address: *

Credit Line Requested: *

Type of Company: *

AlphaCard Account #:

Company Name: *

Doing Business As:

Company Website: *

A/P Invoice Contact: *

A/P Invoice Phone: *

Fax

A/P Invoice Email *

Dun & Bradstreet #: *

Parent Dun & Bradstreet #:

Registered Company Address: *

Previous Address:

City: *

State or Province: *

Zip or Postal Code: *

AGREEMENT

I / We agree to make all payments within our 30 day terms with AlphaCard.
I hereby release any and all credit or financial information to AlphaCard or its assignees.

Full Name: *

Title: *

Date: *

ALL REQUIRED FIELDS (MARKED BY *) SHOULD BE COMPLETE. IF YOU HAVE ANY QUESTIONS, PLEASE CALL 800-717-8080.

Please submit any purchase orders to sales@alphacard.com or to your sales representative.