Please down the
credit application form in PDF or word file below
to set up a new account.
Company Name
Mailing Address
Shipping Address
Phone#
Fax#
Type of Ownership
Years in business
Resale permit#
Tax ID#
Officer/Principals
Title
Name
SS#
Title
Name
SS#
Bank Reference
Name
Phone#
Fax#
Account#
Contact
Address
Trade Reference
Name
Phone#
Fax#
Address
Term
Acct#
Name
Phone#
Fax#
Address
Term
Acct#
Name
Phone#
Fax#
Address
Term
Acct#
Authorization to Release Information
I certify that the information provided in this application is, to the best of my knowledge, correct, and I hereby authorize our bank to release any information to assist in establishing credit with COMIX COMPUTERS INC .
