FAX BACK TO 1-877-283-6416

Application for Credit with

CTAM Inc

1623 Central Ave.

Suite 3

Cheyenne, WY82001CableTiesAndMore

Phone: 1-877-284-7760

Fax: 1-877-283-6416Page 1 of 2

Legal Company Name:______Year Established:______

Doing Business As:______

D & B #: ______

Mailing Address:______Under Present Ownership Since:______

(for invoices/statements)______

Shipping Address:______Business Hours:______

(For more than one branch______

please attach a list)______Carrier information: (*optional*)

Telephone #:______Loomis account#______

Fax#:______Purolator account#______

Website Address:______UPS Act. ______

Officer’s / Owners’ Names:______Title______

______Title______

______Title______

Management Contact:______Title______Phone/Ext______

Email ______

Purchaser:______Phone/Ext______

Email ______

Accounts Payable Contact:______Phone/Ext______

Email______

Do you accept backorders?Circle oneYESNO

Do you want a monthly statement?Circle oneYESNOTax Exemption #______

TERMS: ALL SALES ARE NET 30 DAYS. OVERDUE ACCOUNTS ARE SUBJECT TO A LATE PAYMENT CHARGE.Is your initial order attached? Circle NO YES

MERCHANDISE DISCREPANCIES RECEIVED FROM CTAM MUST BE PORTED WITHIN 3 BUSINESS DAYS. Who is your Sales Rep ______

Officer’s/Owner’s Signature:______Date: ______

Officer’s/Owner’s Name:______

Application for Credit with

CableTiesAndMore

Page 2 of 2

Company

Applying for Credit:______

TRADE REFERENCES (**mandatory**):

**NAME**______

**ADDRESS**______

**FAX**______TEL______

**NAME**______

**ADDRESS**______

**FAX**______TEL ______

**NAME**______

**ADDRESS**______

**FAX** ______TEL______

**BANK**______**TEL**______

BRANCH ADDRESS:______ACCOUNT ______

I have read, understand and accept the above terms. I have provided true and correct information to the best of my knowledge. I further authorize CTAM to verify any and all references we have given that may be required to determine our credit capabilities and to request relevant information from credit reporting agencies. I promise full and prompt payment of all indebtedness incurred for merchandise and/or services furnished by CTAM should it be come necessary to assign any outstanding balance to a licensed Collection Agency or the State Court, all subsequent collection charges and legal fees shall be paid by the applicant.

Officer’s/Owner’s Signature:______Date:______

Officer’s/Owner’s Name:______

NOTE: PLEASE EMAIL APPLICATON TO r fax to 1-877-283-6416.