Detailed instructions for use are in the User's Guide.
CONFIDENTIAL CREDIT APPLICATION
To Purchase:
Hydro Systems Company Products
or
Nova Controls Products
NOVA CONTROLS
LEADING THE WAY
A Hydro Systems Company
3798 Round Bottom Road - Cincinnati, OH 45244 Telephone: (513) 271-8800 or (800) 543-7184 Â Fax: (513) 842 2596
225 Westridge Drive Watsonville, California 95076
You can now access our Confidential Credit Application on our Website: www.hydrosystemsco.com PLEASE PRINT CLEARLY Division or Subsidiary of: City: City: Fax: State: State: Zip: Zip:
Company Name: Billing Address: Shipping Address: Telephone:
Time in business under present ownership:
(
)
(
)
PO# Required? YES NO OK to backorder? YES NO
E-mail address: Type of Business: ____Chemical Distributor ____ Chemical Mfg ____Equipment Distributor Other (explain): Federal ID#: Resale# (required): Type of Entity: ___Proprietorship ___Partnership ____Corporation ___Other D&B Rating: Duns#:
Owners/President/Chief Financial Officer
Name Title
Three Suppliers Currently Extending Credit
Name 1. 2. 3. Address, City, State, Zip Telephone Fax (required)
Banking References (Main Office and/or Branch)
Name Bank Account #: Credit Line Requested (required): $___________________ Estimated Monthly Purchases:$____________________ Address, City, State, Zip Telephone Fax (required)
Terms of Sale: Upon granting credit, payment is due within 30 days of invoice date. Payable only in U.S. funds. Overdue accounts will be subject to 1 1/2% per month service charge. HYDRO SYSTEMS reserves the right to collect reasonable legal and filing fees, court costs and any other expenses that they may incur in order to collect an account that must be placed with a third party. I authorize HYDRO SYSTEMS to check our credit status with any of the references listed on this application. *A REQUIRED SALES TAX EXEMPTION CERTIFICATE IS TO BE ATTACHED.*
Signature of responsible party (required): _________________________________________________Title:___________________________________________ PLEASE PRINT NAME:_____________________________ Date:_________________________________________
FOR HYDRO TO PROCESS YOUR APPLICATION PROMPTLY, PLEASE COMPLETE ENTIRE FORM, RETURN TO ACCOUNTING HYDRO SYSTEMS FOR INTERNAL USE ONLY (once approval has been confirmed, we will notify you by returning this application back to you by fax, with this section completed) TERM/LINE OF CREDIT APPROVED:____________________________ APPROVED BY:______________________________________ DATE:_______________________ ACCT. NO.:_________________________________ SALES REP:________________________
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