Fields marked with an asterisk (*) are required to process your credit application.   Contact Information Title Mr. Mrs. Ms. Dr. Last Name* First Name* E-mail* Fax ( ) - - Phone* ( ) - - Extension   Company Information   Company Name* Position or Title Company Street Address 1* Company Street Address 2 City* State or Province* Postal Code* Country (if outside US)* Billing Address 1 (if different from above) Billing Address 2 City State or Province Postal Code Country (if outside US)   New Customer Existing Customer End User Reseller Distributor OEM Describe Company* Sole Proprietorship Partnership Corporation D & B Number* Registration/EIN Number* Names, Titles, and Phone Numbers of Principals/officers* Name Title Phone ( ) - ( ) - ( ) - Accounts Payable Supervisor Name* Bank Name* Bank Street Address 1* Bank Street Address 2 City* State or Province* Postal Code* Country (if outside US)* Phone*( ) - Account Number* Three Supplier References* Company City/state Account Number Desired Credit Limit* Select one 1K 5K 10K 25K 50K 100K By submitting this application, I authorize MAMAC Systems to contact references and to obtain information from outside sources that may be needed to obtain credit. I certify that this application has been carefully prepared and is complete, accurate, and correct. If my account is accepted, I agree to pay according to MAMAC Systems' terms of sale which are net 30 days. A service charge of 2% with 24% APR will be charged on all past due accounts. I further agree to pay all collection costs and expenses, including reasonable attorneys' fees, incurred by MAMAC Systems in collecting or attempting to collect such account. Comments