Application for Account with Credit Terms

Application for account with credit terms, 30-day terms at SpeechRecPros (speechrecpros.com).

Company Information
Company Name*
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Fax
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Years in Business*
Number of Employees*
Tax ID*
Dunn and Bradstreet Number

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Business Information
Bank Name*
Bank Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name
Account Number*

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Trade References
Company One
Phone
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Company Two
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Company Three
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number

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Terms Agreement
I (WE) UNDERSTAND AND AGREE TO THE CREDIT TERMS OF NET 30 DAYS FROM INVOICE DATE AS STATED ON EACH INVOICE AND THE CONDITIONS DESIGNATED BY TRANSCRIPTIONGEAR.COM. I (WE) HEREBY CERTIFY THAT THE INFORMATION ON THIS APPLICATION IS CORRECT, COMPLETE AND AUTHORIZE TRANSCRIPTIONGEAR.COM TO INVESTIGATE THE SUBMITTED INFORMATION AND MAKE ANY INQUIRIES AS IT DEEMS APPROPRIATE REGARDING OUR STANDING AND CREDIT WORTHINESS. ALL CHANGES REGARDING OUR INFORMATION WILL BE PROVIDED FORTHWITH.

SUBMISSION OF THIS FORM WITH THE "AUTHORIZED BY" BOX COMPLETED SHALL CONSTITUTE AN "ELECTRONIC SIGNATURE" AUTHORIZING TRANSCRIPTIONGEAR.COM TO PROCESS THIS APPLICATION.
Name*
First Last
Title*
Date*
MM slash DD slash YYYY

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Departmental Contacts
Please provide your department managers or person(s) to contact in the following areas:
Accounting Contact
First Last
Title
Phone
Purchasing Department Contact
First Last
Title
Phone
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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Company Information