Call Us Today !!!   800-322-5887 • 401-831-8030 • Fax 401-831-8032   
| | | | |
CREDIT APPLICATION
 
COMPANY NAME and ADDRESS: please give your company name & address exactly as they are to appear in our records
             
  (optional)        
     
         
             
 
GENERAL INFORMATION:
             
             
             
CONDITIONS AND AGREEMENT OF CREDIT SALES - CREDIT AUTHORIZATION (Click here for details)
  Date:    
PERSONAL GUARANTEE (Click here for details)
     
     
    I personally guarantee the payments of all invoices, within terms issued by New England medical Supply, Inc. for products accepted
      by myself, my company or my clients. Any and all legal claims to be litigated in the State of Rhode Island.
For W-9 form (click here)
 
BANK REFERENCE:
             
             
     
             
             
 
MAJOR SUPPLIER 1:
       
         
     
         
             
 
MAJOR SUPPLIER 2:(optional)
       
         
     
         
             
 
MAJOR SUPPLIER 3:(optional)
       
         
     
         
             
                 

| | | |