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BLANK Credit APP

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PM International Suppliers, LLC.

REQUEST FOR CREDIT INFORMATION


BUSINESS CONTACT INFORMATION

Company name: DASSAULT SYSTEMES


Phone: Fax: +33 (0) 9.70.44.79.21 E-mail:
Registered company address:
City: Province/State: Postal/ZIP Code:
Country:
A/R Contact:
BUSINESS AND CREDIT INFORMATION
Primary business address:
City: Province/State:
Postal/ZIP Code Country:
Telephone: Fax: E-mail:
Bank name:
Bank address: Phone:
City: Province/State: Postal/ZIP Code:
Type of account Account number
Savings
Checking

BUSINESS/TRADE REFERENCES
Company name:
Address:
City: Province/State: Postal/ZIP Code:
Phone: Fax: Contact & email:

Company name:
Address:
City: Province/State: Postal/ZIP Code:
Phone: Fax: Contact & email:

Company name:
Address:
City: Province/State: Postal/ZIP Code:
Phone: Fax: Contact & email:

AGREEMENT
1. All invoices are to be paid within terms dictated by PM International and will be from the date of the invoice.
2. By submitting this information, you authorize PM International to make inquiries into the banking and
business/trade references that have been supplied.

AUTHORIZED SIGNATURE

Title:
Date:

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