Fillable Customer Credit Application (City of Oakland)

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Customer Credit Application (City of Oakland)

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The Customer Credit Application (City of Oakland) form is 2 pages long and contains:

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  • 94 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Oakland

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Customer Credit Application
Please complete all information requested in page one and two to ensure timely processing of this request
Gases for Life | Gaz pour la vie
General Business Information
Owner/Partner/Director/Shareholder Name: Title:
Address: Phone: Fax:
City: State/Prov: Postal Code:
Business Details
Legal Registered Business Name:
Trade/Banner Name (operating as):
Please indicate which buying Group you belong to, if Not applicable write N/A. ___________________________________________
Bill To Address:
Company Name:
Messer Canada Inc. sends all invoices electronically, fees apply to
paper invoices.
Do you require a PO? Yes No
Is it a blanket PO? Yes Per Delivery? Do you require a release?
E-billing E-mail:
Address:
Phone: Fax:
City:
State/Prov: Postal Code:
Ship To Address:
Address:
Please note any special requirement or restrictions:
Phone: Fax:
Preferred Delivery Days: _______________________________
Messer will do everything possible to meet your requested delivery day.
City:
State/Prov: Postal Code:
E-Commerce - shop.messer-ca.com - provides access to order online from 10,000 items or view and print your cylinder holdings, invoice copies,
proof of deliveries and make payments on-line. If you require more information, please contact webshop@messer-ca.com or 1-888-256-7359
Contact Information
Accounts Payable contact name
Would you like an online account for Messer WebShop? Yes No
Should user have access to invoice copies? Yes No
Phone:
E-mail:
Buyer contact:
Would you like an online account for Messer WebShop? Yes No
Should user have access to invoice copies? Yes No
Phone:
E-mail:
Safety contact: (Safety Data Sheets recipient)
Would you like an online account for Messer WebShop? Yes No
Note: Messer sends SDS electronically.
Phone:
E-mail:
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Customer Credit Application
3670E_1020
Please complete all information requested in page one and two to ensure timely processing of this request
Customer Name: Title: Signature: Date:
Please submit the completed form to your local branch or to our credit department department: credit@messer-ca.com
The Applicant certifies that all statements made in this application including any attachments are true and complete and are made for the purpose of obtaining an account with Messer Canada Inc.
("Messer") and for the purpose of securing credit with Messer. The applicant authorizes Messer to make all enquiries it deems necessary to investigate the applicant’s financial status including obtaining
and receiving information from the Applicant’s bank, credit references and Third Party Agencies. The Applicant consents to Messer’s collection, use, and disclosure of the Applicant’s personal information
as discussed herein and for the purposes set forth herein. The Applicant acknowledges and agrees that Messer General Terms and Conditions (which may be amended from time to time by Messer)
apply on all purchases of goods and services under the trading account and that by signing and returning this Application to Messer, Applicant agrees to be bound by such terms and conditions, as may
be amended from time to time. Current versions of the terms and conditions can be obtained upon request.
Office Use Only
Legal Entity/Division Doing Business with Messer Canada Inc.
Approval Name: Signature: Limit: Date:
Sales Rep Name: Sales Rep #: Branch #: MS #: Cust #:
Dunning Clerk #:
Proprietorship Partnership Corporation Franchise Hospital Government Non-Profit
Incorporated Certificate # Limited Liability Company
Estimated Monthly Purchases:
If Financial Statements or Payment and Performance Bonds are available, please provide copy
What is the type of business or SIC/NAICS Code:
Is your company Tax exempt: Yes No If yes, a copy of your Exemption Certificate is required for eligibility
Bank And Trade References
Name of Bank
Address of Bank
Contact Name: Tel: Account #: Email address:
1. Trade Ref Name: Contact: Tel: Email address:
2. Trade Ref Name: Contact: Tel: Email address:
3. Trade Ref Name: Contact: Tel: Email address:
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Customer Credit Application (City of Oakland)

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Completed 9 August 2021

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