Please complete and submit the form below. After we have reviewed your application, a professional account manager will contact you.

Should you prefer to mail or fax your application, please download our printable version and follow the instructions included.

If you have a question about a credit application you've already sent, please call (330) 785-5200.

Downloadable Credit Application

Credit Application

* indicates a required field

Contact Information

First Name:*

Last Name:*

 

Address:

City:

State:

Zip Code:

E-Mail Address:*

Telephone:*

FAX:

Company Information

Company Name:*

DUNS Number:

Type of Company:

Corporation Partnership Sole Proprietership Other

Federal Tax ID:

Tax Exempt?

Yes No

Tax Exempt Code:

Years in business:

Request Credit Amount:

 

Accounts Payable Contact

First Name:

Last Name:

 

E-mail Address::

Telephone:

Billing Information

First Name:

Last Name:

 

City:

State:

Zip Code:

Email:

Telephone:

Shipping Information

check if same as "Bill To" information

First Name:

Last Name:

 

City:

State:

Zip Code:

Email:

Telephone:

Authorized Buyers

Authorized Buyer #1

First Name:

Last Name:

 

Email:

Telephone:

Authorized Buyer #2

First Name:

Last Name:

 

Email:

Telephone:

Authorized Buyer #3

First Name:

Last Name:

 

Email:

Telephone:

Credit Terms

Applicant authorizes the release to Advanced Computer Services, Inc. ("Vendor"), of Applicant's general credit and financial information and authorizes Vendor to investigate and obtain credit reports with and from credit reporting agencies, banks, bonding companies, credit references, owner, officers, shareholders, parties to this Application, and others.

Applicant acknowledges and agrees that: (1) all outstanding credit amounts are payable within 20 days of the date of invoice and otherwise in accordance Vendor's terms of sale; (2) delinquent payments will be subject a service charge of 1.5% per month (18% per annum), but in no event greater than the maximum rate allowed by law; (3) costs or expenses incurred by Vendor in the enforcement of Applicant's obligations or the collection of amounts are recoverable by vendor as an additional credit advances herein (including but not limited to Vendor's reasonable attorney's fees and costs); (4) Vendor reserves the right to modify or discontinue without notice at any time and from time-to-time, any of the terms of credit herein with respect to future purchases. Applicant further acknowledges that each purchase by Applicant will constitute a commercial transaction; that all statements and representations herein are true and correct; that Applicant has read and understands the above terms, conditions, and covenants; and that Applicant's obligations are governed by the laws of the State of Ohio, and that the proper venue for any dispute will be in the Superior Court of Summit County.

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ACS, Inc.
2262 S. Arlignton Road
Akron OH, 44319
Email: sales@dellmedic.com
Phone: 330-785-5200
Fax: 330-785-5201

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