CREDIT APPLICATION

  

LAN WAN Enterprisesrequires that a proper credit application be filled out in order for use to extend credit to other businesses. Below is a form which may be filled and submitted online.

After the form has been reviewed, LAN WAN Enterprises will fax you an acknowledgement form, which requires your signature.

We cannot guarantee the security of the information being submitted online through this form. If you wish, you may choose from the following alternatives to the online application:
Application on File
A text version of the credit application is also available here. This form may then be filled out and sent as an attachment to an E-mail to accounting@lanwansys.com or faxed to us at 732-382-9127, at your convenience.
Request by Phone
If you choose, we can send you a hard copy of the credit application via fax. Call us at 732-388-5285 for an application. After the application has been filled out, it can be faxed to us at 732-382-9127 or mailed to us at the following address:

LAN WAN Enterprises
151 Westfield Ave.
Clark, NJ 07066
ONLINE FORM
* = required field
Company Name

Address

Billing Address

Phone Number

Fax Number

E-Mail Address

Tax ID#


Form of Business

Type of Business

Annual Sales

Number of Employees

How long has your firm been in business? years

Name & Title of Officers / Principals




Purchasing Agent

A/P Supervisor

Credit Limit Requested


Bank Name

Bank Phone Number

Bank Address
City, State Zip

Bank Contact Name

Type of Account

Bank Account Numbers

Trade Reference #1:

Name

Address

Phone Number

Trade Reference #2:

Name

Address

Phone Number

Trade Reference #3:

Name

Address

Phone Number



The above information is for the purpose of obtaining credit and is warranted.

We authorize the firm to whom this application is being made to investigate the references listed pertaining to our credit and financial resposibility.

Application Submitted By:

Title:

 
 
 
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