Business Account
Credit Card/CODApplication
Optimus, Inc.
3765 Winchester Rd
Memphis, TN 38118
901-365-1269
 
Please Fax Completed Form to 901-259-1175
Date:______________
Business Name___________________________________ Business Phone_______________
Billing Adress_________________________________________________________________
City, State, Zip________________________________________________________________
Check if this address is a residence Phone No. _________________ Fax No.__________________
Check one:
Individual
Partnership
Corporation
Under State Laws______
Owners_____________________ Buyer's Name______________________ Year Opened________
Sales Tax Status: We are Taxable Exempt State No.__________________(include certificate)
Varies by Purchase Order Other (Please Indicate)_______________________________
 
 
Set me up as:
COD
Credit Card
Send Credit Application
  Credit Card Type___________Card No________________________ Exp Date_____________
  Bank__________________________________________________________________________
  Bank City, State, Zip___________________________________________________________
  Account Name________________________ Account No._________________________
 
  Optimus is a repair parts wholesaler selling exclusively to retail/repair/ service companies, who are actively peforming in the swimming pool/spa business. It is not possible for such companies to suceed in buying only from us. You must utilize another supplier for whole goods.
  List one suppplier_______________________City ______________________ Phone __________________
  Otherwise submit a business license indicating you are in the pool business, or a voided check, a business card, or some other proof that you are in the trade.
 
 
Authorized Signature___________________________ Title_________________________________
 
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