BFO Credit Application

CREDIT APPLICATION FOR NET 30 TERMS

BFO BuyFittingsOnline.com
A Division of QMC Technologies, Inc
4388 Broadway • Depew • New York 14043
bfo@qmctechnologies.com • 1-800-569-0810
Company Name:*
Parent Company Name (If Different):
Billing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accounts Payable Contact Name: *
AP Phone Number:*

Area CodePhone Number
AP E-mail for Invoices:*
example@example.com
Business Type:*
Years in Business:*
DUNS & BRADSTREET Number:*
Requested Credit Limit Amount $:*
Tax Exempt
Tax Exempt:
Upload Tax Exempt Certificate:

Browse Files

Cancelof
Bank References
(1) Bank Name: *
(1) Bank Phone Number:*

Area CodePhone Number
(1) Bank Account #:
(1) Bank Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(2) Bank Name:
(2) Bank Phone Number:

Area CodePhone Number
(2) Bank Account #:
(2) Bank Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Trade References
(1) Reference Name: *
(1) Reference Phone Number:*

Area CodePhone Number
(1) Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
(2) Reference Name: *
(2) Reference Phone Number:*

Area CodePhone Number
(2) Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
(3) Reference Name: *
(3) Reference Phone Number:*

Area CodePhone Number
(3) Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
I certify that the above-provided information is true to the best of my knowledge. I understand that providing false documentation including tax exemption documents or failure to provide accurate and legitimate information, may result in loss or termination of established Net 30/credit terms at the discretion of BuyFittingsOnline.com & QMC Technologies, Inc.
Authorized Signature:
Date

MonthDayYear
Date
Position/Title:
Email
example@example.com
** PLEASE ALLOW 5-7 BUSINESS DAYS
FOR PROCESSING AND REVIEW DUE TO CURRENT VOLUME OF REQUESTS **
Should be Empty:

Tax Exempt

Bank References

Trade References