Apply for your I.C.D.M. Inc. credit now.  -Print this form
Simply fill in the form below and click submit. All credit applications are processed immediately, and we will contact you the next business day regarding your application.

I.C.D.M. Inc. Credit Application
Step One: Company Information
Company Name:
Billing Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Type of Business:
Years in Operation:
Telephone:
Email Address:
Part Two: Names of officers and their titles
Officer 1 Name:
Title:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Social Security No:
Officer 2 Name:
Title:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Social Security No:
Officer 3 Name:
Title:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Social Security No:
Step Three: Trade References
Reference 1 Name:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Phone:
Reference 2 Name:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Phone:
Reference 3 Name:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Phone:
Step Four: Bank Information
Principle Bank:
Address:
City:
State:	AKALARAZ CACOCTDC DEFLGAHI IAIDILIN KSKYLAMA MDMEMIMN MOMSMTNC NDNENHNJ NMNVNYOH OKORPARI SCSDTNTX UTWAWIWVWY
Zip:
Phone:
Account Number:
Bank Officer:
Step Five: Payment Terms Service charges of 2% will be assessed on overdue balances. Accounts exceeding 30 day period will be subject to restricted credit. Payment records dictate the acceptable limits of credit. Unauthorized deductions or discounts will be considered overdue and billed back on account.
Annual Sales Volume:
Credit Limit Requested:
Est. Monthly Purchase:
Billing Requirements:
As evidenced by submitting this form the information in this application is true and factual and provided to Industrial Control Design and Maintenance Inc. for the purpose of the extension of credit. Permission is granted to contact references or any other source to obtain credit information. We agree to make payments in accordance with invoice terms and to pay monthly service charges when added on overdue balances. The undersigned warrants that the individual executing this application is authorized to do so and to bind the applicant to the liabilities and obligations set forth.
Company Name:
Date:
Applicant's Name:
Applicant's Title:
Applicant's Email: