Credit Application

If you need to expedite your order (while you are waiting for your open account application with Markertek to be approved), we suggest that you use a credit card and submit your order(s) via this website / or contact customer service: (800) 522-2025.

Please Complete All Sections Click Here for a Hard Copy to Fax or Mail.

Type of Credit Requested: Credit Card C.O.D. Company Check NET 20 Days Open Account Status

I prefer Paperless Billing

Billing Information
Name Of Firm	Subsidiary Of
Street	Type Of Business
P.O. Box	Resale/Sales Tax No.
City State Zip	SS# Or F.E.I.N.
Country	DUNS#
Phone Fax*	Check One: Corporation Partnership Proprietorship
Email*

Shipping Information
Street
P.O. Box
City State Zip

Purchasing Name	A/P Name
Purchasing Phone Fax	A/P Phone Fax
# Of Years in Business # Of Employees	Year Established
Business Operates From Own Building Office Building Home Other
How did you find out about Markertek Video Supply: Catalog/Mailing Customer Referral Publication Other

Although I have provided my e-mail and fax number, I do not* wish to receive promotional faxes and e-mail sent by Markertek.

We charge sales tax for orders shipped in New York State. If you are a tax-exempt New York State purchaser, please FAX a copy of your resale certificate to 845-246-1757. I certify that all statements made by me in this application are correct to my knowledge. I authorize Tower Products to investigate and verify the information I have provided herein.
Your name Title Date

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