Application for Credit

Company Name

Web Address

Buyer's Name

Telephone Number

Email Address

Fax Number

Address Line 1

City

Address Line 2

State

Postal Code

Country

Shipping address is same as billing address

Contact Name (if different than Billing)

Telephone Number

Fax Number

Address Line 1

City

Address Line 2

State

Postal Code

Country

AP Contact

AP Telephone Number

AP Email

AP Fax Number

Credit Line Requested

Terms Requested

Tax ID #

Duns #

Tax Exempt

Resale Certificate must be uploaded (AL, CA, CO, IL, MA, MN, and TX)

Do not Insure

Evidence of insurance must be uploaded

Freight Collect

Upload Bank Information and at least 3 Trade References

Please select a file

I've read and accept SymmetryElectronics.com Terms & Conditions of Use

The undersigned agrees that all information submitted here is true and correct. By submitting this application, you authorize Symmetry Electronics to make inquiries into the banking and business trade references that you have supplied. I understand and agree to pay freight, insurance and sales tax if the necessary information/documents above are not provided. I agree to the Symmetry Electronics Corporation terms and conditions of sale:

Signature

Date

Title

reCAPTCHA

Credit Application: Please complete form and upload the following documents.

1 Bank trade reference (for funds verification) The following information is required:

Bank Name
Account Number
Bank's contact information
Name, Telephone Number, Email Address, Fax Number

3 trade references. The following information is required:

Company Name
Address
Phone Number
Email Address
Fax Number