ACC Climate Control - Credit Application

If you prefer, you may use an alternate version of our Credit Application form.
It is also available in Word or PDF format.

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Name of Firm or Individual
Address
City
State
Zip
Years At This Address
Phone
Fax
E-Mail
HEREBY applies for credit in accordance with the terms and conditions of:
TO:		ACC Climate Control ATTN: Carey Harris, Controller 22428 Elkhart East Boulevard PO Box 1905 Elkhart, Indiana 46514 TERMS: NET 30 (COD until credit application approved)
The following information must be provided. It will be held in the strictest confidence:
Corporation Partnership Individual Check here if incorporated within the past 12 months.

Ownership Name(s) of Principal(s):
1.	Name
	Complete Address
	Phone
2.	Name
	Complete Address
	Phone
3.	Name
	Complete Address
	Phone
4.	Name
	Complete Address
	Phone

Finance
Bank Name
Bank Address
Bank Officer or Department
Phone

References
1.	Business Name
	Complete Address
	Phone
2.	Business Name
	Complete Address
	Phone
3.	Business Name
	Complete Address
	Phone
4.	Business Name
	Complete Address
	Phone
Check here if cash sales are okay until credit is approved.
I certify that all the information in this credit form is correct. I fully understand your credit terms and agree to the proper paymnet in consideration of extended credit. TERMS: I hereby certify that the statements in this application for open account credit are true and complete. By my signature below, I hereby agree to pay all bills when same become due or payable pursuant to the terms of the sale. I further agree to pay all interest charges, not to exceed 1 1/2% per month, on any past due balances, if applicable, and all collection cost plus reasonable attorneys fees in the event action is commenced against me for non-payment.
Signed:
Please note: By typing your name in this box and submitting this form you are signifying that you agree to the terms and conditions set forth in this Application for Credit and that your action in typing your name will be considered your legal signature and your affirmation and acceptance of this Application for Credit. We may require your written signature before extending credit and you will be notified if the same is required.
Title:
Date Submitted:
Comments:

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ACC Climate Control
22428 Elkhart East Boulevard
PO Box 1905
Elkhart, Indiana 46514
574.264.2190 Phone
800.462.6322 Toll Free
574.266.6744 Fax
E-Mail