Credit Application

To set up a customer account with net 30 terms (subject to credit review and approval), please fill out the application form below. Filling out an application is easy and usually takes less than 10 minutes.

If you have any questions, please contact our corporate offices at 888-265-5632, or email us at APInvoices@accent-control.com

If granted credit, I agree to pay all invoices according to your terms of Net 30 days, Accent Control Systems reserves the right to cancel applicant’s credit at any time without notice. In the event Accent Control Systems commences litigation or employs attorneys in order to secure payment of any sums due it from applicant, the applicant agrees to pay attorney and/or collection expenses, plus interest at 1.5% per month (18% annually) in addition to balances owed. The undersigned acknowledges that the above agreement has been carefully read and that the applicant understands and agrees to the same.

* All fields marked with an asterisk are required to be filled out before the form can be submitted.

Business Information

* Company Full Name * Company Phone Number    Company Fax Number * Company Billing Address 1    Company Billing Address 2 * Company City * Company State / Province * Company Zip / Postal Code * Company Country * Company Email Address * Company Contact	* Years in Business * Product Sold/Mfg.    D&B Number * Federal Tax ID * Type Of Business Corporation Partnership Individual * How should we invoice you? Mail to billing address Email invoice to: Fax invoice to:
Business Owners or Officers   Name Title   1)   2)
Trade References (Businesses currently selling to your firm)   Reference #1 Reference #2 Reference #3 Reference #4 Name  *   *   *   *  Address                     City                     State                     Zip                     Phone                     Fax  *   *   *   *  Email  *   *   *   *
* Do You Qualify For State Sales Tax Exemption?    YesNo If yes, please send us a copy of your sales tax exemption certificate: Email: APInvoices@accent-control.com Or upload a copy here: (PDF Required)