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
YES.....
NO......
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?
YES.....
NO......
Own or Lease property at business location.
Own
Lease
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 ______________________________________________