Credit application for companies wanting to purchase used Cisco and Juniper; please read if ordering.

Coastside Networking buys and sells used
and refurbished Cisco, Juniper and Netscreen

CREDIT APPLICATION

If you prefer, you may print & fax this form to 925-688-2388.

All fields must be completed; incomplete forms can not be processed.

Firm's Legal Name:

DBA:

Address:

City:

State:

Zip:

Email:

Phone:

Fax:

Website:

Full Name of Owner or Owners, or an Authorized Officer if Corporation:

1)
2)

Please check one:

Proprietorship
Partnership
Corporation

If a proprietorship or partnership, have you ever done business under another name?

Yes No

If a proprietorship or partnership, have you ever declared bankruptcy?

Yes No

Does your company have a branch or subsidiary located in California:

Yes No

Federal Tax ID#:

Dunn & Bradstreet #:

Type of Business:

Date Started:

Est. Annual Sales:

Accts Payable Contact:

Accts Payable Email:

Accts Payable Phone #:

Accts Payable Fax #:

Purchasing Agent:

Purchasing Agent Phone #:

Purchasing Agent Email:

Credit Limit Desired:

Credit Terms:

Net 15
Net 30

- TRADE REFERENCES -

Name:
Address:
City:
State:
Zip:
Email:
Phone:

Name:
Address:
City:
State:
Zip:
Email:
Phone:

Name:
Address:
City:
State:
Zip:
Email:
Phone:

Name:
Address:
City:
State:
Zip:
Email:
Phone:

- BANK INFORMATION -

Name of Bank:

Account #:

Street Address:

City:

State:

Zip:

Contact:

Phone:

If the information wherein this agreement is not paid by the date indicated, and it is necessary to take steps to collect on this debt, then the customer agrees to pay all reasonable collection costs, including attorney fees, which are necessary to collect the debt. These terms and conditions and the sale subject hereto shall be governed by the laws of the State of California without regard to its conflict of laws and principles. In the event any proceedings or suit is brought regarding these terms and conditions and the sale subject hereto, such suit shall be brought in the courts of Contra Costa County, California, the parties hereby agree to personal jurisdiction in said court(s). The person signing/submitting this application certifies that all the application contained in this application and any attachments, is true and correct to the best of their information, knowledge, and belief and that they are authorized to sign on behalf of their company. The person signing/submitting this application authorizes the above references to release the applicable credit information.

We require that all new customers applying to do business with Coastside Networking read and accept our Terms and Conditions. If you have not read our Terms and Conditions, please do so now. If you agree with its conditions, please sign below. By signing, you state that you have read our Terms and Conditions and that you fully accept its terms and provisions in full without reservations.

Coastside Networking is a subscriber to Dun & Bradstreet's Commercial Collection Services

Firm Name:

Your Name:

Title:

Date:

By entering your name above, you are entering your signature, which is legally binding. Your IP address is also being logged to protect against fraud.

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Coastside Networking buys and sells used and refurbished Cisco, Juniper and Netscreen

CREDIT APPLICATION

Coastside Networking buys and sells used
and refurbished Cisco, Juniper and Netscreen