Application for Credit
This document must be completed in full. For any questions on completing, or to return completed form, please contact [email protected] Fluke’s W-9 is located at http://us.fluke.com/fluke/usen/about/tax/default.htm
Anticipated annual sales volume with Fluke $ Name of Sales Rep for this account
Legal Name Tax ID Street Address City/State/Zi p Phone Fax
COMPANY BACKGROUND Year Started Type of Business (mfg, retail, etc.) D&B Number Number of Locations President / CFO Accounts Payable contact information Type of Organization (corporation, partnership, etc.) Financial Responsibility (self, parent, other, etc.) Affiliated or Other Business Interest (name, address,relationships, type(s) of business)
FINANCIAL INFORMATION Bank Name & Acct. Phone Address Officer Release Acct # Attached Bank Name & Acct. Phone Address Officer Release Acct # Attached
CREDIT REFERENCE INFORMATION: Please provide credit references with a similar sales volume as that listed above, or similar credit limits for the amount of your current / pending orders. Please also note that our credit decision will require a response from the provided references. Informing them that we will be contacting them, and / or ensuring their prompt reply will help to reduce the waiting period on your credit decision. Phone USA Supplier’s Name & Address Fax Number Number 1
2
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4 CURRENT FINANCIAL STATEMENT INFORMATION IS REQUIRED FOR ALL CREDIT LINES OVER $5,000. Most recent Financial Statement (Balance Sheet and Income Statement) attached. Circle one Yes or No If Sales are Non-Taxable, is Valid tax cert attached? Circle one Yes or No Name, Title, & Phone of person we can contact for further credit information
RELEASE OF INFORMATION
Fluke Credit Department Telephone e-mail Internet PO Box 9090 M/S 258C Everett WA 98206.9090 USA 800-265-6985 [email protected] www.fluke.com The above information is for the purpose of obtaining commercial credit and is warranted to be true, correct and complete. Creditor is hereby expressly authorized to investigate the references herein listed or other data obtained from applicant. Applicant also authorizes the above bank to release information regarding checking account and/or loan relationships and balances.
Authorized Title Dat Signature: e
Fluke Credit Department Telephone e-mail Internet PO Box 9090 M/S 258C Everett WA 98206.9090 USA 800-265-6985 [email protected] www.fluke.com