Account Application

Contact Information
4242 South Broadway
Englewood, Colorado 80113
Phone: (800) 726-0851
Phone: (303) 794-3928
Fax: (303) 794-3704
email: sales@adcopro.net

Account Application

Make your ordering easy - establishing an account today will help to expedite your order, save time, and C.O.D. charges. Fill out and submit this form, and one of our account representatives will be in touch with you to confirm your application.

Company Information

Company Name
Address:
City:
State or Province:
Zip Code:
Country:
Business Type:	Sole Proprietorship Partnership Corporation In State Of:
Number of Years in Business
Social Security or Federal ID Number
Number of Locations
Tax Resale Number
Name(s) of Individual/Partners/Corporate Officers:
Name of Person to Contact Regarding Purchase Orders:
Name:
Title:
Address:
Phone Number:
Email:
Bank References:
Bank Name (1):
Address:
Contact Name:
Phone Number:
Account Number:
Account Type:
Bank Name (2):
Address:
Contact Name:
Phone Number:
Account Number:
Account Type:
Trade References:
Company Name (1):
Address:
Contact Name:
Contact Title:
Phone Number:
Account Number:
Company Name (2):
Address:
Contact Name:
Contact Title:
Phone Number:
Account Number:
Company Name (3):
Address:
Contact Name:
Contact Title:
Phone Number:
Account Number:
The above information is herewith submitted for the purpose of opening an account and I do hereby certify this information to be true. Terms of open accounts are Net 30 days, 18 percent interest is charged on past due accounts and I agree to these terms.
Your Name:
Title:
Today's Date: