Zeus New Account Credit Reference Form

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Powercell Battery Products
191 Covington Drive
Bloomingdale, IL 60108
Phone: (630) 295-6800
Fax: (630) 295-6801
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Print the form and fill in the information by hand, or click in the field with the hand tool to enter information with
Acrobat Reader before printing the page for faxing. If you have a full version of Acrobat, you can save the
completed form and email it to
To: Power-cell Sales Department Fax: (630) 295-6801
Company Name:
Phone:
Fax:
Address:
City:
State:
Zip:
Date :
Accounts Payable Contact:
Accounts Payable Phone #:
Type of Business
____ Proprietorship
____ Partnership
____ Corporation
Federal ID #:
Resale #:
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Company Name:
Contact:
Phone:
Fax:
Address
City:
State:
Zip:
Company Name:
Contact:
Phone:
Fax:
Address
City:
State:
Zip:
Company Name:
Contact:
Phone:
Fax:
Address
City:
State:
Zip:
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Bank Name _______________________ Account Officer _____________________ Account #:
Bank Address _________________________________________________________________________________
Contact:
Phone:
Fax:
I authorize the above stated references to provide Power-cell Battery Products, LLC, with any information in their
possession regarding their business experience with my company or me.
___________________________
Signature
Print Name
Title
Date

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