Satellite ORBIT

Online Media Kit
Credit Application

Please print out this form and fax the completed version to Jodi Kuraner at 703-251-3010 or mail to Jodi Kuraner at CommTek Communications Corporation, 9302 Lee Highway, Suite 600, Fairfax, VA 22031.

The persons signing this application certify that all of the information contained in this application and any attachments is true and correct.


Exact name of business


DBA if applicable


Customer #


Year Established


Division if applicable


Mailing Address


Street


City, State, Zip

Location of Corporate Offices (if different than mailing address)


Street Address


City, State, Zip


Phone


Fax

Legal Status (circle one):

Sole Proprietorship
Partnership
Corporation
Limited Liability Company

Please provide name(s) and social security number(s) of owner(s)/principal(s) of the Applicant:


President/CEO


Controller/CFO


State of Incorporation or Registration of Partnership

CREDIT REFERENCES
(Please include three creditors with which you have an open account).

Reference #1:


Name


Address


City/State/Zip


Phone


Fax


Contact

Reference #2:


Name


Address


City/State/Zip


Phone


Fax


Contact

Reference #3:


Name


Address


City/State/Zip


Phone


Fax


Contact

BANK REFERENCE


Name of Bank and Branch


Phone


Contact


Account #(s)


I authorize the bank to release information on the above account(s).

This is an application for credit. CommTek Communications Corporation reserves the right to extend, deny or terminate credit based on the terms of this agreement. By signing this agreement, applicant agrees to:
1) Allow CommTek Communications Corporation credit personnel to contact trade, bank references and outside reporting agencies for the purpose of establishing credit.
2) Provide financial statements, if necessary, to establish credit.
3) Pay invoices within 30 days or be assessed 1 1/2% per month finance charge.
4) Be responsible for any attorney fees or collection costs incurred as a result of delinquency.
5) CommTek Communications Corporation may request updated credit information for the purpose of maintaining credit terms with an account.


Signature


Date


Print name of signatory

Please print out this form and fax the completed version to Jodi Kuraner at 703-251-3010 or mail to CommTek Communications Corporation, 9302 Lee Highway, Suite 600, Fairfax, VA 22031

©2000 CommTek Communications Corporation.
All Rights Reserved.
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