Minnesota Telephone | Secure Credit Application

All customers who request an open account or COD company check status must fill out this form. If MN Telephone, Inc. ships our merchandise and does not receive payment according to terms, we will charge your credit card account. This would be done only when all other methods of collection are exhausted.

Credit Card Information

Company Name:
Billing Address:
City:
State:
Phone:
Card Number:
Card:
Expiration Date:
Drivers License:
Social Security #:



Where/How did you hear about MN Telephone, Inc.?




Have you or your company ever purchased from us before?






Does your company employ a purchase order number system?
If yes:

List all persons authorized to make purchases.


Billing Name:
Billing Address:
City:
State:
Phone:
Shipping Name:
Shipping Address:
City:
State:
Phone at shipping address:
Email:

Do you agree to these terms?
I (herein referred to as "Company"), hereby personally guarantee the payment to MN Telephone, Inc. in the state of Minnesota, of any obligation of the Company and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Company whenever the company shall fail to pay the same. It is understood that this guarantee shall be continuing and irrevocable guarantee and indemnify for such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice hereof and consent to any modification of the credit agreement hereby guaranteed.
I accept the above terms: