Account Application

  OKW ELECTRONICS - ACCOUNT APPLICATION FORM

 Camden Home
 E-Mail Us
 Order Form
 Tel 866-603-7701
 Fax412 220 9247
 

CONTACT DETAILS
Mr/Mrs/Ms
First Name
Last Name
Job Title
E-mail

COMPANY DETAILS
Company
Address1
Address2
City
State
ZIP
Phone
   
Year Company Established
 
Company Type
 
Federal EIN #
 
State of Incorporation
 
Years Operating At Current Address
 
Estimated Credit Per Month $
 

BILLING ADDRESS (If Different)
Address1
Address2
City
State
ZIP
Phone

We will usually confirm your application within 24 hours. (Depending upon references)

NON-ACCOUNT ORDERS
We also accept credit cards (AMEX, VISA or MASTERCARD), or can issue pro-forma invoices.

  

BANK DETAILS

Bank
Account #
Address1
Address2
City
State
ZIP
Phone
Contact

CREDITOR REFERENCE 1
Company
Account #
Address1
Address2
City
State
ZIP
Phone

CREDITOR REFERENCE 2
Company
Account #
Address1
Address2
City
State
ZIP
Phone

CREDITOR REFERENCE 3
Company
Account #
Address1
Address2
City
State
ZIP
Phone


   
Tel: (800) 965 9872  Last Updated: 10-Aug-2009 ©OKW Enclosures, Inc. USA. All rights reserved.