Your Sterilizer Experts

Distribution – Maintenance- Guaranteed!

 

   Alfa Medical                                                                                          1-800-762-1586

   265 Post Avenue                                                                                    516-280-7822

   Westbury, NY 11590                                                                            516-977-7434 fax

                                                                                                                 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.