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Credit Application

 

Please complete this form and click "Submit" to apply for a line of credit with TCS Basys Controls®. Or, use this link to download a printable version of the form, complete it and fax it to 608.836.9044.

If you have questions or need immediate assistance, please call us at 800.288.9383 or 608.836.9034.

Submitting this form servers as authorization for the listed bank and credit references to release information to TCS Basys Controls®. By submitting this form, I certify that all the information on this form is correct. I also certify that I and my company fully understand that TCS Basys Controls' ® credit terms (Net 30 days) and agree to the proper payment in consideration for extended credit.


pdf icon Credit Appliation (PDF)

Registration Information
Name of Person Completing Form
Email Address
Date of Form Completion
Company
Billing Address
Address Line 2
City
State
Zip/Postal Code
Country
Phone
Fax
Accounts Payable Contact

At this point, you may click "Submit" below and then fax a copy of your bank and credit references to 608.836.9044. Or, you may continue filling in the form and click the "Submit" button at the end of this form.

 
line
Business Information
Line of Business
Years in Business
Dun & Bradstreet #
Name(s) of Principal/Managing Partner/Owner
Corporation Partnership Invididual
Sales Tax Status (select one)
We are Tax Exempt. NOTE: A Tax Exemption Certificate must be faxed to TCS at 608.836.9044.
We are NOT Tax Exempt. NOTE: You will be responsible for tracking, reporting, and paying any applicable state sales tax(es) on your own.
TCS does not collect, report or pay sales taxes for ANY states (except WI, FL and CA).

Bank Information
Bank Name
Bank Contact
Address
Address Line 2
City
State
Zip/Postal Code
Account #
Account Type
Phone
Fax
Credit Reference
Credit Reference #1
Contact Name
Address
City
State
Zip/Postal Code
Account #
Phone
Fax
Credit Reference #2
Contact Name
Address
City
State
Zip/Postal Code
Account #
Phone
Fax
Credit Reference #3
Contact Name
Address
City
State
Zip/Postal Code
Account #
Phone
Fax
Credit Reference #4
Contact Name
Address
City
State
Zip/Postal Code
Account #
Phone
Fax
Thank you for your interest in TCS Basys Controls®.
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