Midmark Corporation Request for Credit Terms

Complete this form and you will be contacted by a member of our team

 

 

Business Information
Billing Country
Billing State
Billing Province
Parent Country
Parent Company State
Parent Company Province
Tax Exempt

Account Payable Contact Information

Communication Preferences (Default: US Mail)

Invoices sent by:
Ex: (555) 555-5555
[email protected]
Statements sent by:
Ex: (555) 555-5555
[email protected]

AUTHORIZATION

The above information is warranted to be true and complete. Applicant submits this information with the agreement to Midmark terms and conditions of sale which are available at www.midmark.com or a copy can be provided upon request. If Midmark expressly authorizes approval of credit, Applicant shall make full payment within thirty (30) days of the invoice date. Midmark may at any time modify or revoke credit, and credit references may be requested upon review.
By selecting this box you are providing your authorization and approval of the above information.
Date format mm/dd/yyyy