Your
Sterilizer Experts
Distribution – Maintenance- Guaranteed!
Alfa Medical 1-800-762-1586
265 Post Avenue
Westbury, NY 11590
Web site www.sterilizers.com
Credit Application
Company
or individual Name ________________________________________ Date
________________
Address______________________________________________________
City_________________________________
State_______ Zip____________
Phone____________________________
Do you own your building? – Mortgage company
name_________________________________ Phone___________________
Do you rent your building? – Landlord
name_________________________________________ Phone___________________
Type
of business: Corp £ Partnership
£ Sole
Prop £
Individual £
If Company - Owners or Partners
Name
Title Home
Address
1.
___________________________________________________________________________________________________
2.
___________________________________________________________________________________________________
3.
___________________________________________________________________________________________________
Bank
Name___________________________________________ Bank
Phone_____________________________
Bank
Address_____________________________________________ City_______________________
State______ Zip_________
Bank
Officer Contact___________________________ Account#____________________________________________
References How long doing business? Credit
Amt Balance
Name____________________________________ _________ _________ _________
Address_______________________________________
City____________________ State_______
Zip________
Name____________________________________ _________ _________ _________
Address_______________________________________
City____________________ State_______
Zip________
Name____________________________________ _________ _________ _________
Address_______________________________________
City____________________ State_______
Zip________
Credit will be given only to customers who can commit to multiple & consistent purchases.