Castellano Electric Motors
147 Ridge Street NY,N.Y. 10002 Tel (212)-254-7040
After completing application, Print, SIGN and Fax To: 212-677-8207
Registered Trade Name    

Street City State Zip
Type of Business Date Business Started Telephone #
Owner's Name Owners Home Address
Taxable Yes / No If Tax Exempt, Enter Tax I.D. Number
Name of Bank Bank Account Number Bank Telephone #
Person Handling Your Account Bank Address
1st Trade Reference Address Telephone #
2nd Trade Reference Address Telephone #
3rd Trade Reference Address Telephone #
Can you meet our terms of payment. ( Net 30 Days.) Yes / No?
Own or Lease property at business location.
If Tax Exempt, Please enclose your tax exemption certificate
Terms of sale, including price, terms of payment and charges, for each purchase are agreed to be those specified on the face of each invoice. The customer hereby agrees to pay all cost of collection or legal fees should such action be necessary due to non payment.
Owner's Name Title Date


Owner's Signature ______________________________________________