General Credit Information
Print and Fax to: 626-791-9327
   
Company Name:
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Home Address:
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Bank Information:

Bank Name:                                                       Branch:

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Contact Name:                                                           Mr.        Ms.
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Required line of credit:
Supplier Reference #1

Name:

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Existing Credit Limit:
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Supplier Reference #2

Name:

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Existing Credit Limit:
Existing Credit Term:
Supplier Reference #3

Name:

Address:
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Existing Credit Limit:
Existing Credit Term:

The undersigned:

1. Applies to VideoCom Inc (VCI). for the initiation and/or extension of Trade Credit upon VCI's standard terms.

2. Agrees to be bound by VCI's condition of sales policy.

3. Authorizes and consents to the receipt and exchange of credit information by VCI with any credit reporting agency or credit bureau.

4. Agrees to be liable for charges to account with VCI and will be required to pay in full all invoices and/or debit notes issued to it, by VCI upon the terms and conditions provided for in such invoices and/or debit notes.
Company name:
Signature of Officer:
Signature of Witness:
Name of Officer:
Name of Witness:
Date:
Date: