Your Sterilizer Experts

Distribution Maintenance- Guaranteed!

 

Alfa Medical          1-800-762-1586

265 Post Avenue               516-280-7822

Westbury, NY 11590 516-977-7434 fax

Web site www.sterilizers.com

Credit Application

 

Company or individual Name ________________________________________ Date ________________

Address______________________________________________________

 

City_________________________________ State_______ Zip____________

 

Phone____________________________

 

Do you own your building? Mortgage company name_________________________________ Phone___________________

Do you rent your building? Landlord name_________________________________________ Phone___________________

 

Type of business: Corp Partnership Sole Prop Individual

 

If Company - Owners or Partners

 

Name Title Home Address

 

1.                   ___________________________________________________________________________________________________

 

2.                   ___________________________________________________________________________________________________

 

3.                   ___________________________________________________________________________________________________

 

Bank Name___________________________________________ Bank Phone_____________________________

 

Bank Address_____________________________________________ City_______________________ State______ Zip_________

 

Bank Officer Contact___________________________ Account#____________________________________________

 

References How long doing business? Credit Amt Balance

 

Name____________________________________ _________ _________ _________

 

Address_______________________________________

 

City____________________ State_______ Zip________

 

 

Name____________________________________ _________ _________ _________

 

Address_______________________________________

 

City____________________ State_______ Zip________

 

 

Name____________________________________ _________ _________ _________

 

Address_______________________________________

 

City____________________ State_______ Zip________

Credit will be given only to customers who can commit to multiple & consistent purchases.