Control Components, Inc.

Billing Information:
Bill to Name :
Bill to Address:
Phone:
Fax:
Email:
Shipping Address: Enter shipping info if different from above.
Ship to Name:
Address:
Phone:
Fax:
Trade References: (Please furnish three)
Name:
Address:
Phone:
Fax:
Name:
Address:
Phone:
Fax:
Name:
Address:
Phone:
Fax:

Bank Reference:
Bank Name:
Address:
Phone:
Fax:
Sales Tax Information:
Are you tax exempt:
	If yes you must send Control Components Inc., your a sales tax exempt form or you will be billed accordingly.

Name of person completing this form:
TERMS OUR TERMS ARE NET 30 DAYS. WE SHIP VIA UPS; PREPAY AND ADD FREIGHT TO INVOICES UNLESS OTHERWISE REQUESTED. INSTRUCTIONS: IF NOT SUBMITTING ELECTRONICALLY PLEASE FAX COMPLETED APPLICATION AND TAX EXEMPTION CERTIFICATE IF APPLICABLE TO: CONTROL COMPONENTS, INC. 712 OLIVER ROAD MONTGOMERY, AL 36117 ATTENTION: ACCOUNTING FAX: 334-264-5803