Nova controls CREDITAPP User Manual

CONFIDENTIAL CREDIT APPLICATION

To Purchase: ο Hydro Systems Company Products or ο Nova Controls Products

3798 Round Bottom Road - Cincinnati, OH 45244
Telephone: [phone] or [phone] – Fax: [phone]

You can now access our Confidential Credit Application on our Website: www.hydrosystemsco.com

PLEASE PRINT CLEARLY

Company Name: Division or Subsidiary of:

NOVA CONTROLS

L E A D I N G T H E W A Y

A Hydro Systems Company

225 Westridge Drive

Watsonville, California 95076

Billing Address: City: State: Zip:

Shipping Address: City: State: Zip:

Telephone: Fax:

( ) ( )

E-mail address:

PO# Required?

Type of Business: ____Chemical Distributor ____ Chemical Mfg

____Equipment Distributor Other (explain):

Federal ID#:

Resale# (required):

YES NO OK to backorder? YES NO

Time in business under present ownership:

Type of Entity: ___Proprietorship ___Partnership

____Corporation ___Other

D&B Rating: Duns#:

Owners/President/Chief Financial Officer

Name Title

Three Suppliers Currently Extending Credit

Name Address, City, State, Zip Telephone Fax (required)

1.

2.

3.

Banking References (Main Office and/or Branch)

Name Address, City, State, Zip Telephone Fax (required)

Bank Account #:

Credit Line Requested (required): $___________________ Estimated Monthly Purchases:$____________________
Terms of Sale: Upon granting credit, payment is due within 30 days of invoice date. Payable only in U.S. funds. Overdue accounts

will be subject to 1 1/2% per month service charge. HYDRO SYSTEMS reserves the right to collect reasonable legal and filing fees,
court costs and any other expenses that they may incur in order to collect an account that must be placed with a third party.

I authorize HYDRO SYSTEMS to check our credit status with any of the references listed on this application.

Signature of responsible party (required): _________________________________________________Title:___________________________________________

*A REQUIRED SALES TAX EXEMPTION CERTIFICATE IS TO BE ATTACHED.*

PLEASE PRINT NAME:_____________________________ Date:_________________________________________

FOR HYDRO TO PROCESS YOUR APPLICATION PROMPTLY, PLEASE COMPLETE ENTIRE FORM,

RETURN TO ACCOUNTING

HYDRO SYSTEMS FOR INTERNAL USE ONLY

(once approval has been confirmed, we will notify you by returning this application back to you by fax, with this section completed)

TERM/LINE OF CREDIT APPROVED:____________________________ APPROVED BY:______________________________________

DATE:_______________________ ACCT. NO.:_________________________________ SALES REP:________________________