Albuquerque - Taos - Roswell | (505) 407-2310 HOME ABOUT INDUSTRIES PRODUCTS SERVICES STATE CONTRACTS CONTACT US CREDIT APPLICATION Fill out our online form or download a pdf of the form to fill out by hand. Click on the icon above to download a pdf version of the Credit Application. Credit Application Fields marked with an * are required Company Information Name * DBA/Company * Mailing Address Mailing Address Mailing City Mailing State - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Mailing Zip Shipping Address Shipping Address Shipping City Shipping State - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Shipping Zip Contact Information Contact Name Email Phone Fax Company Profile Company Type Corporation Partnership Franchise Sole Proprietor Date Business Started Type of business Tax ID Resale Number Officers or Principals 1. Name 1. Title 2. Name 2. Title Accounts Payable Billing Option Mail Email AP Contact Name Phone AP Email Purchase Order Required Yes No Persons Authorize to Purchase Credit References 1: Company 1: Address 1: Account Number 1: FAX 2: Company 2: Address 2: Account Number 2: FAX 3: Company 3: Address 3: Account Number 3: FAX Please Confirm: I certify that I am authorized by my employer to apply for open account terms and the information provided in the application is true and correct. I am agreeing to comply with all terms of open accounts as set forth by Ten-Four Communications who also reserves the right to change terms at any time, without notice. I understand that Ten-Four Communications reserves the right to begin charging 1.5% per month on all outstanding balances past due. I hereby authorize the release of credit information requested relevant to the above account for the attainment of a credit report from a credit reporting agency. I understand that application for terms in no way constitutes approval by Ten-Four Communications. I Confirm Person Filling our the form Title Totays Date Recaptcha HOME ABOUT INDUSTRIES PRODUCTS SERVICES STATE CONTRACTS CONTACT US All Rights Reserved 2021 © Code 3 Service