Data ID On Line Credit Application

Please fill out credit application and hit submit. Upon submitting a popup window will appear. Please print and sign this page and fax it back to us at 408-354-9533. We will have already begun to process your request although we cannot complete the transaction without your signature.

COMPANY DATA

Today's Date (mm/dd/yy)

Trade Style or Firm Name

If Corporation, Full Corporation Name

Business Address

Address (cont.)

Mail Stop

City

State/Province

Zip/Postal code

Country

Work Phone

FAX Number

URL Web Address

Date Established

At Present Location Since

OWNER DATA

Corporation

Partnership

General Partnership

Sole Proprietorship

If Incorporated, Date Incorporated

LIST OF OWNERS, PARTNERS, AND/OR OFFICERS

Name

Title

Home Address

Home Address 2

Home Phone

Name

Title

Home Address

Home Address 2

Home Phone

Have any of the above ever had a business failure or filed any type of bankruptcy proceedings? Yes No

If yes, please describe fully:

State Sales Tax#/Resale

Issued by State

Federal Tax ID#

Describe your business operation

Number of Employees

Is your business owned or leased Owned Leased

BANK/LENDING INSTITUTION REFERENCE

Name

Branch

Account Number

Contact

Address

Address 2

Phone

City

State

Zip/Postal code

CREDIT REFERENCES

Company Name

Address

Address 2

City

State

Zip/Postal code

Phone Number

FAX Number

Company Name

Address

Address 2

City

State

Zip/Postal code

Phone Number

FAX Number

Company Name

Address

Address 2

City

State

Zip/Postal code

Phone Number

FAX Number

BUSINESS INFORMATION

Buyer

Accounts Payable Contact

Receiving/Shipping Contact

Describe fully any UCC filings on your business assets

CONTACT INFORMATION

Your Name (First, Middle, Last)

Your Title

Your Phone Number

Your Email

The above information is submitted for the purposes of obtaining credit. The undersigned authorizes you to make such inquiries as are necessary to obtain credit information and authorize my bank, suppliers, and credit references to release information regarding my account(s).
I / We agree to pay all legal costs including collection agency fees, costs, legal costs and reasonable attorney's fees if it becomes necessary to enforce collection or file suit.

I / We certify that everything stated on this application is true and correct to the best of my / our knowledge.

I have read and agree with the terms and conditions of sale YES


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Phone 408-354-7733 | Fax 408-354-9533 | email sales@dataid.com

COMPANY DATA
Today's Date	(mm/dd/yy)
Trade Style or Firm Name
If Corporation, Full Corporation Name
Business Address
Address (cont.)
Mail Stop
City
State/Province
Zip/Postal code
Country
Work Phone
FAX Number
URL Web Address
Date Established
At Present Location Since
OWNER DATA
Corporation
Partnership
General Partnership
Sole Proprietorship
If Incorporated, Date Incorporated
LIST OF OWNERS, PARTNERS, AND/OR OFFICERS
Name
Title
Home Address
Home Address 2
Home Phone
Name
Title
Home Address
Home Address 2
Home Phone
Have any of the above ever had a business failure or filed any type of bankruptcy proceedings? Yes No If yes, please describe fully:
State Sales Tax#/Resale
Issued by State
Federal Tax ID#
Describe your business operation
Number of Employees
Is your business owned or leased	Owned Leased
BANK/LENDING INSTITUTION REFERENCE
Name
Branch
Account Number
Contact
Address
Address 2
Phone
City
State
Zip/Postal code
CREDIT REFERENCES
Company Name
Address
Address 2
City
State
Zip/Postal code
Phone Number
FAX Number
Company Name
Address
Address 2
City
State
Zip/Postal code
Phone Number
FAX Number
Company Name
Address
Address 2
City
State
Zip/Postal code
Phone Number
FAX Number
BUSINESS INFORMATION
Buyer
Accounts Payable Contact
Receiving/Shipping Contact
Describe fully any UCC filings on your business assets
CONTACT INFORMATION
Your Name (First, Middle, Last)
Your Title
Your Phone Number
Your Email
The above information is submitted for the purposes of obtaining credit. The undersigned authorizes you to make such inquiries as are necessary to obtain credit information and authorize my bank, suppliers, and credit references to release information regarding my account(s). I / We agree to pay all legal costs including collection agency fees, costs, legal costs and reasonable attorney's fees if it becomes necessary to enforce collection or file suit. I / We certify that everything stated on this application is true and correct to the best of my / our knowledge.