Amphenol Aerospace
40-60 Delaware Ave
Sidney NY 13838
REQUEST FOR APPROVAL OF CREDIT LINE
Customer Name and Billing Address: Contact Information:
A/P Name: ________________________ Phone #: ( ) ___________________ Fax #: ( ) _____________________ Email:
____________________________ ____________________________________________________________________________________________________________________________________________________
D&B #________________________________ Years in Business_____________________
Tax ID # ______________________________ Type of Business______________________
Please attach the information identified below for (1) Bank Reference and (3) Trade References:
Bank Reference Trade Reference (provide 3)
Name: _____________________________ Address: ___________________________ Phone #: (
)_____________________ Fax #: (
)_______________________ Contact Name: ______________________ Name: _____________________________ Address: ____________________________ Phone #: (
) _____________________ Acct #: (
)______________________ Contact Name: _______________________
The Amphenol Credit Department will review the information provided above. Our standard terms are “Net 30 Days” (invoice date). If standard terms can not be authorized, a Credit Representative will contact you with other terms options. Thank you.
Amphenol Credit Department
Fax #: (607)563-5751
Amphenol Credit Department
Use Only:
Initial PO# _________________________ Shipper # _________________ $ ______________
Comments: ____________________________________________________________________
Rating
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Terms ______ Credit Limit $___________ Recommended by ___________________________
/ /
Approvals: Credit Manager(up to $75K) ______________________________ / /
Controller (up to $150K) ________________________________ / /
General Manager (up to $1,000K) _________________________ / /
Amphenol Treasurer (over $1,000K) _______________________ / /
DT 10/06/03