Credit Application

To apply for credit terms with DAS Services, Inc, you can either fill out the form below with as much information as possible, fax your original form to 949-582-8694, or e-mail it to info@dasservicesinc.com. If you have a Resale Certificate ID please include that as well. If you have any questions please do not hesitate to call us at 949-582-3908.

General Information

Name Of Company:
Years Established:
Type Of Business:
Resale Number:
Federal ID #:
Accounts Payable Contact:
      
Billing Address:
City:     State:     Zip Code:
      
Shipping Address:
City:     State:     Zip Code:
     

Trade References
    
Reference #1:
Company Name:
Address:
Phone #:
Fax #:
Contact Person:
    
Reference #2:
Company Name:
Address:
Phone #:
Fax #:
Contact Person:
    
Reference #3:
Company Name:
Address:
Phone #:
Fax #:
Contact Person:
    

Bank Reference
   
Bank Name:
Address:
Phone #:
Fax #:
Contact Person: