Business Credit ApplicationApply for Net Terms for your Company or Business. Our default credit terms are Net 30 (30 days) unless otherwise specified by Cable and ConnectionsPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1Company Information2Accounting Contacts3Bank Reference4Vendor Reference 15Vendor Reference 26Vendor Reference 37ConfirmationCompany Information LayoutToday's Date *Company Name *Date Business Established *Subsidiary Of (If Applicable)Requested Credit Limit *Billing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeShipping Address (If Different)Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutPhone NumberFax Number (If Applicable)NextAccounting Contacts Accounts Payable Contact *FirstLastAccounts Payable Email *Invoicing Contact *FirstLastInvoicing Email *PreviousNextBank Reference Bank Name *LayoutPhone Number *Fax Number (If Applicable)Bank Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBank Contact Name *FirstLastBank Contact Title *PreviousNextVendor References Must have a minimum of 3 Vendor References to be considered for Credit Terms Vendor 1 LayoutVendor Name *Account Number *Vendor Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVendor Contact Name *FirstLastVendor Contact Title *LayoutVendor Contact Email *Vendor Phone Number *PreviousNextVendor References Must have a minimum of 3 Vendor References to be considered for Credit Terms Vendor 2 LayoutVendor Name *Account Number *Vendor Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVendor Contact Name *FirstLastVendor Contact Title *LayoutVendor Contact Email *Vendor Phone Number *PreviousNextVendor References Must have a minimum of 3 Vendor References to be considered for Credit Terms Vendor 3 LayoutVendor Name *Account Number *Vendor Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVendor Contact *FirstLastVendor Contact Title *LayoutVendor Contact Email *Vendor Phone Number *PreviousNextConfirmation and Agreement of Credit Terms Your Cable & Connections Sales Rep (If Applicable)I give my permission for the release of information to Cable and Connections Acquisition Company LLC about my account(s). If the applicant is a corporation, the undersigned personally guarantees the prompt payment and performance of any obligation of the applicant. A charge of 1.5% will be added monthly on past due balances. The individual by signing this credit application/agreement is executing this application on behalf of Buyer and personally guarantees, and agrees to be personally liable for failure of the performance by Buyer of, any and all of Buyer's obligations under this application with Cable and Connections Acquisition Company LLC. The personal guarantee also applies in the event that the Buyer declares for Bankruptcy Protection. Company Name *Applicant's Name *FirstLastApplicant's Title *Applicant's Signature (Type in Full) *Today's Date *Guarantor's Name *FirstLastPreviousSubmit Form
