IC REAL TECH, INC. 3050 N Andrews Ave EXT Pompano Beach,FL33064,US Phone:(866) 997-9009Fax:(866) 860-3860 Credit Application System -(English) 1Credit/Company Info 2Owners/Principal Info 3References 4Ship, Bill, A/P Info 5Electronic Signature 6Submit Request Credit Request Credit amount requested USD Planned monthly purchase --------- Select --------- Account with us (Existing customer) ? NO YES Acct # Order pending ? NO YES Amount: Sales/Customer Service Rep Select Rep --------- Select --------- Company Description LEGAL Company Name Trade/DBA Name Country United States of America Address Line 1 Address Line 2 City State/Province -select state- Zip/Postal Code Phone Fax Business Profile Organization Type --------- Select --------- Style of Business --------- Select --------- Year Established (YYYY) State/Province of Incorporation -select state- Number of Employees --------- Select --------- Annual Sales --------- Select --------- Company Identification Federal Tax ID DUNS Number Tax Exempt Certificate Is this a Tax Exempt purchase or service? NO YES Applicant's Contact Info Title --------- Select --------- First Name Last Name Work Phone E-mail Re-Type E-mail Save & Continue later Next Privacy Policy | Terms Of Use © Copyright 2010 - 2021 Bectran, Inc. All rights reserved