Ophthalmic & Optical Equipment & Supply - Armstrong Optical

Wednesday June 19, 2013
. . . . . . . . . . . . .

. . . . . . . . . . . . .

Home Page
. . . . . . . . . . . . .

Products
. . . . . . . . . . . . .

About Armstrong
. . . . . . . . . . . . .

What's New?
. . . . . . . . . . . . .

FAQs
. . . . . . . . . . . . .

Service
. . . . . . . . . . . . .

Links & Resources
. . . . . . . . . . . . .

News & Articles
. . . . . . . . . . . . .

Contact Info
. . . . . . . . . . . . .

SITE MAP

. . . . . . . . . . . . .

Subscribe
to our email newsletter

. . . . . . . . . . . . .

Armstrong Optical
P.O. Box 450
2700 South Park Ave
Denison, Texas 75020
903-463-2023
800-627-5054

Credit Application

Complete this form to apply for an Armstrong Optical account. To speed processing, be sure to provide complete infomation.

Fields with a red arrow are required.

Full Business Name:
Street Address:
City:
State:
State/Prov:	(Non-US Applications)
Country:
Zip/Postal Code:
Telephone:
Fax:
Email:
Contact:
Type Of Business:
Time in Business:	Years
Fed ID#:
Type Ownership:

Principals:
	Principal 1
Name:
Title:
Percent of Ownership
Social #:
(H) Address:
(H) City:
State:
Zip/Postal Code:
Telephone:
	Principal 2
Name:
Title:
Percent of Ownership
Social #:
(H) Address:
(H) City:
State:
Zip/Postal Code:
Telephone:

Bank References Provide information on at least one of your bank accounts.

Name	Type of Account	Account #	Telephone	Contact Name


Trade References Provide information on three trade references, preferably in the optical or medical supply business.
Name	Contact	Account #	Telephone	Fax

Credit Release

I hereby authorize our banks, trade references and financial institutions to release credit information to Lessor and further authorize Lessor to obtain other credit information including D&B reports and Credit Bureau Reports.

D.Hart & Associates: Website Design & Search Engine Optimization