Corporate Sales Division

Account Application

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Tell us about yourself

First Name
Last Name
Title
Email

Tell us about your company

Company Name
Type of Organization Corporation(End User) Corporation(Reseller) Government Institution Educational Institution

Billing Details


Street
City
Country
State		Zip
Business Phone		Fax

Purchase Plan

Resale Certificate # (for resellers only)

Anticipated Monthly Purchase

Referred By (Company's or Sales Person's Name)

Federal Tax ID

Trade References

Company Name	Address	Zip	Credit Limit/ Terms

Payment Details

Name of Bank	City
Account #	State	Zip
	Phone #

I authorize and grant E-Max Group, Inc., its assignees or agents, permission to obtain from any credit source or agency, including the undersigned’s banks and accountants, complete credit information concerning the undersigned. Further, the undersigned warrants and represents that all information contained in this Application and any other statements and documents submitted to E-Max Group, Inc., by the undersigned are true, accurate, correct and complete. A late charge of 1.5% per month can be assessed on accounts past due beyond our terms. Service charges and/or bank fees required to obtain credit information may be passed through.

I have read and agree to the Terms & Conditions

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