Communications Supply Corporation

Financing

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* - denotes required fields

*First Name:

*Last Name:

Title:

*Company:

*Email:

*Address Line1:

Address Line2:

*City:

*State:

*Zip:

*Phone:

Fax:

BILLING INFORMATION

Billing First Name:

Billing Last Name:

*Billing Contact:

Billing Title:

Billing Email:

*Billing Phone:

Billing Fax:

billing address is the same as contact address

*Billing Company:

*Billing Address Line1:

Billing Address Line2:

*Billing City:

*Billing State:

*Billing Zip:

WHICH BEST DESCRIBES CONTACT?

*Describe Contact:

You buy yourself you buy for others you specify product

ACCOUNT CATEGORY

*Installers:

EC-Electrical Contractor
LVI-Commercial Low Voltage System Integrator
PNC-Public Network Contractor
RESI-Residential Low Voltage Contractor
SI-System Integrator
SOUND-Commercial Sound Contractor
TEMP-HVAC Contractor
VDC-Private Net

*Distributors:

ELD-Electrical Distributor
EW-Electrical Wholesaler
WIRE-Wire and Cable Specialist

*End Users:

AERO-Aerospace
AUTO-Automotive
COM-Computer Manufacturing
CON-Consumer Goods Manufacturing
E-Energy
ED-Education
ENT-Entertainment
FIN-Financial Services
FOOD-Food Processing
HC-Health Care
INS-Insurance Companies
INT-Internet Companies
ME-Miscellaneus End User
MFG-Industrial Manufacturing
P&P-Paper and Pulp
RD-Research and Development
RET-Retailing
SOFT-Software Services & Manufacturing
SVCS-Services, Law & Accounting
TEL-Telecommunication

*Public Networks:

BLEC-Business Local Exchange Carrier
CAP-Competitive Access Provider
CATV-Cable Television Operating Company
CLEC-Competitive Local Exchange Carrier
DOT-Dept of Transportation
IOC-Independent Operating Company
ISP-Inernet Service Provider
LEC-Local Exchange Carrier
MUNI-Municipality
RBOC-Regional Bell Operating Company
UTIL-Utilities
WHC-Web hosting Company

*Government:

FG-Federal Government
LG-Local Government
SG-State Government

BANK REFERENCE

*Bank Name:

*Reference Contact:

*Reference Phone:

*Checking Account #:

*Checking Date Opened:

Average Balance:

Rating:

Loan Account:

Loan Date Opened:

Balance:

Hi Credit:

*Terms Category:

Secure Unsecure

Terms:

TRADE REFERENCES

1. Trade:

Phone:

Reference:

Opened:

Hi Credit:

Balance:

Past Due:

Terms:

Promptness:

2. Trade:

Phone:

Reference:

Opened:

Hi Credit:

Balance:

Past Due:

Terms:

Promptness:

3. Trade:

Phone:

Reference Contact:

Opened:

Hi Credit:

Balance:

Past Due:

Terms:

Promptness: