Please download this form.
Return completed form via fax to 503-684-8164.

Credit Application

                                                                                                                 Application Date: _____________
Business Name: ________________________________________________________________________

Billing Address: ________________________________________________________________________

                 City: _______________________________ State:_______________ Zip: _________________

Shipping Address:_______________________________________________________________________

                 City: ______________________________ State:________________ Zip: _________________

               Phone:________________________________ Fax:____________________________________

Contact Personnel:                   Authorized Buyer: ______________________________________________

                                                 Accounts Payable: ______________________________________________

Date of Establishment:____________________          

Type of Organization (check one) :      Sole Proprietor _______ Partnership _______  Corporation _______

If Corporation,  State of Incorporation:________________________________________________________
Owners or Principals (Sole Proprietor or Partnership):

1.           Name: _____________________________________   Title: _______________________________

Home Address: __________________________________________________________________________

                 City: ___________________________________ State: _______________Zip: _______________

2. Name: ______________________________________  Title: _____________________________

Home Address:  __________________________________________________________________________

                 City: ___________________________________ State: _______________Zip: _______________


Financial Information
Federal Tax ID Number:___________________________________________________________________

Fiscal Year End:______________________ Requested Line of Credit: $ U.S._________________________


Bank Reference
Name/Branch:____________________________________________________________________________

Address: ________________________________________________________________________________

City: _________________________________  State: ________________________ Zip: ________________

Contact Personnel: ____________________________ Account Number:____________________________

Trade References (Minimum of Three Required):

       Company                   Contact                         Address                              Phone                        Fax

1) _____________________________________________________________________________________________

2) _____________________________________________________________________________________________

3) _____________________________________________________________________________________________


By Signing this application, the applicant agrees to the following provisions:
1. The business relationship between the applicant and Sensoray, if any, shall be governed by Sensoray
Standard Terms of Sale, distributor agreements (if applicable), and cost schedules.  Any additional or different
terms in the applicant's business forms shall be void and of no effect.
2. The applicant agrees that the extension of credit is at the discretion of Sensoray's credit department and
accounts that become past due may be put on prepay/COD.
3. The applicant will pay all costs of collection incurred by Sensoray including attorney fees and collection
agency fees (collection fees not to exceed 25% of the total debt.), whether or not any legal proceeding is initiated.
4. The applicant understands that purchase invoices will be mailed one time (via mail post) at the time of product shipment, and that Sensoray will not provide a follow-up invoice statement.  It will be the applicants'
responsibility to pay on time as agreed under the established credit terms.
5. If items are returned other than for defect, the customer will pay a restocking fee of 25% of the original purchase price.  The customer will also pay for all shipping.                                                              
6. The information contained herein is for the purpose of obtaining credit and is warranted to be true.  I/We hereby authorize Sensoray Co., Inc. to investigate the references listed above pertaining to my/our credit and financial responsibility.

Signature/Date: ___________________________________________________________________________

Printed Name: ____________________________________________________________________________

Application must be signed in order to be processed

7313 SW Tech Center Dr., Tigard, Oregon 97223, USA
ph:(503) 684-8005    fx:(503) 684-8164