Customer Credit Application
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10Data Connect Enterprise, Inc. (DCE)/ARC Electronics
3405 Olandwood Court, Olney, Maryland 20832
Phone 301-924-7400 FAX 301-924-7403
Customer Credit Application
Name of applicant_____________________________________ (exact business name)
_____________________________________ (doing business as)
Dun & Bradstreet #____________________
Street address__________________________________________________________________
City____________________________________ State_______________ Zip Code__________
Phone No.___________________ Fax No.____________________ Year established________
Federal Tax ID No._________________ State Resale or Exemption No.__________________
Ownership type (check one) ____ Sole Proprietor ____ S Corporation ___ C Corporation ____
_____ Partnership ___ Other
Public Corporation _____
Private Corporation _____
If Corporation, state of incorporation___________ Registered to do business in MD __yes___no
Date of Incorporation _____ State ____
Are you a subsidiary ___ or division ___(if yes, check which)
Parent Company Name: ______________________________________________
Address: __________________________________________________________
City: ______________________ State: _________________ Zip: _____________
Will the Parent Company guarantee debts? Yes __ No __
Please indicate your company’s primary line of business:
_____ System Integrator
____ Service Provider
_______ VAR
_____ Water/Power/Utility
____ Education
_______ Government
_____ Manufacturing
____ Charitable Organization
Requested Terms (check one)
___ Wire/Check Prepayment
___ COD-company check
Amount ____________
___ Credit Card
Amount ____________
___ Net 30 days open account
Amount ____________
Accts Payable Contact_________________________ Phone # ________________
Fax # __________________________ E-Mail____________________________
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Parent category: Business