Application for Credit

Use the form below to submit an application for credit. Required fields are marked with an asterisk (*).

The information you submit through this secure form is emailed to one of our friendly and knowledgeable support staff.

If you do not wish to use the form below, please download the pdf version, complete and email it to [email protected] or fax it to +1.949.783.7301

Business Information



Enter your business legal entity name.



Enter parent company name.



Enter first line of address.



Enter second line of address if needed.



Enter your city.



Enter 2-letter abbreviation for your state.



Enter your Zip code.



Enter your website URL. (e.g. www.example.com)



Enter company phone number



Enter company fax number



Who is filling out this form?



Enter your job title.



Enter your email address.


OEMCMDistributor

What is the type of business?



What year was your company formed?



Enter your Tax ID or SSN.



Enter 2-letter abbreviation for the State.


YesNo

California businesses will be charged Sales Tax unless a valid tax exemption certificate is provided.



Enter the amount of credit you wish to establish



Enter your tax exempt number here.

Credit References (Major Suppliers)

Attach a MS Word or PDF document with your references listed.


Alternatively, you may complete the following fields:

Credit Reference 1



Enter reference 1 entity name.



Enter reference 1 contact name.



Enter reference 1 phone number.



Enter reference 1 fax number.



Enter reference 1 email address.


Credit Reference 2



Enter reference 2 entity name.



Enter reference 2 contact name.



Enter reference 2 phone number.



Enter reference 2 fax number.



Enter reference 2 email address.


Credit Reference 3



Enter reference 3 entity name.



Enter reference 3 contact name.



Enter reference 3 phone number.



Enter reference 3 fax number.



Enter reference 3 email address.


Accounts Payable Contact



Enter the name of your accounts payable contact.



Enter the phone number of your accounts payable contact.



Enter the address of your accounts payable contact.


PaperEmail

How would you prefer to receive bills?



Email address for billing (if different from AP Contact Email.

Terms and Conditions

The undersigned hereby authorizes any financial instituion or creditor presented with a photocopy of this authorization to release to Suntsu Electronics, Inc. operating under the dba's NEXSUN, SUNTSU, NEMCO and STRAIGHT ROAD ELECTRONICS ("Suntsu") all financial information deemed necessary to formulate a credit decision. Applicant's signature attests financial responsibility and ability of the Company to pay within terms that may be granted by Nexsun. The applicant further acknowledges careful reading, understanding and agreement to Suntsu's Terms and Conditions of Sale which are attached and made part of this agreement. An electronic receipt by fax, email or photocopy of this application will be considered an original copy. I certify that I am authorized and empowered to execute this agreement and to bind the entity. I represent that to the best of my knowledge all of the information presented in this application is true and correct, and understand that Nexsun is relying on this information to extend credit.




Application is to be submitted by an officer or an authorized representative of Company.




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