Associated Microsource America,Inc
14414 Valley Blvd, City of Industry, Ca 91746
Tel:(626)333-9658 Fax:(626)333-9262

 

Financial Authorization

 

To whom it may concern:

 

In order for Associated Microsource America, Inc verify your bank credit references. Please fill out this form and fax back to : (626)333-9262  at your earliest convenience with a your company void check.

Thank you very much for your cooperation.

 

Company Name:
DBA:
Name of  Bank:
Checking Account #:                                                 Total Amount:$
Other Account #:                                                     Total Amount:$
Contact Person:                                                     Title:
Phone:                                    Extension:                              Fax:
Address:
Authorized Signature:                             Title:                          Date:
Comment:

 

BANK USE ONLY
Date of the account established:
Monthly statement average balance:
Any Non-Sufficient Funds or returned checks?       No          Yes
How many NSF check?
Total checking Amount: $
Total Saving Amount:    $
Loan: $                                                      Secured by:
Banker Officer:                                        Title:                      Date:
Phone:                                            Extension:                        Fax:
Comment: