10824 Burbank Blvd.    North Hollywood, CA 91601-2519

(818) 506-1777       Fax: (818) 506-4428

Email: accounting@pantherparts.com

Quality  *  Service  *  Delivery

CREDIT APPLICATION
 Company
Name:
 Shipping Address:
 Billing Address:
City:
State
or Province:
Country:
Zip:
 Phone:
 Fax:
 Contact Name:
 Best Time To
Reach You:
 Your e-mail
address:
Type of business:Corporation Partnership Sole Proprietorship Other
 California
Resale Number:
 Tax ID
Number:
 D&B Rating:
 Under Which Name:
Have You Ever
Done Business With
Panther Parts Ind., Inc.		 Yes  No
 Your Bank:
 Bank Address:
 Bank Phone:
 Bank Fax:
Bank Contact:
 Checking Account #:
--------------------------------------
 Please List 4 Trade References, preferably in the Electronics industry with whom you have open accounts
Reference 1Name:
 Address:
 Phone:
 Fax:
 Contact:
Reference 2Name:
 Address:
 Phone:
 Fax:
 Contact:
Reference 3Name:
 Address:
 Phone:
 Fax:
 Contact:
Reference 4Name:
 Address:
 Phone:
 Fax:
 Contact:

Now accepting Visa and Mastercard
  
 Card Holder Name:
 Card Number:
Card Billing Address: 
 Exp. Date:

    

 

Please allow 2 – 3 business days for your company’s credit to be established. –

Feel free to contact our accounting dept. if you have any questions or comments. ~ Thank You.

 

 

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