Simple Abilities Disablity Products, Equipment and Services

Simple Abilities provides disability products
for work, education, and daily living.

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Offline order FormOffline Order Form
Credit Application FormCredit Application Form

Secure (SSL) Credit Application Form

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Simple Abilities logo
Company Name:
D.B.A.:
Address:
City:
State/Province:
Zip/Postal:
Country:
Telephone:
Fax:
Email:
Length of time in business:
Parent Company:
President/Owner:
Authorized Purchasing Agent(s):
   
Accounts Payable Supervisor:
Accounts Payable Contact:
Telephone:
Fax:
Email:

 Please provide one Bank reference:
Name:
Address:
City:
State/Prov:
Zip/Postal:
Country:
Account Type:
Account Number: Your account number will be encrypted before submission
Contact Name:
Telephone:
Fax:

Please provide three trade references with whom you have Net 30-Day credit terms:
(Please provide Fax Numbers for credit references.)
1# BusinessName:
Address:
City:
State/Prov:
Zip/Postal:
Country:
Type of Business :
Contact Name:
Position:
Telephone:
Fax:
 
2# BusinessName:
Address:
City:
State/Prov:
Zip/Postal:
Country:
Type of Business :
Contact Name:
Position:
Telephone:
Fax:
 
3# BusinessName:
Address:
City:
State/Prov:
Zip/Postal:
Country:
Type of Business :
Contact Name:
Position:
Telephone:
Fax:
In order to insure priority attention to the orders we place with our supplies and orders that our suppliers ship directly to our customers, Simple Abilities provides payment to those suppliers immediately upon confirmation of the transaction. We appreciate your prompt attention to our invoices in order that we may continue to receive and deliver that priority service.

Terms:
Payment due upon receipt of invoice.
Past due accounts (over 30 days)are subject to a 1.5% monthly Finance Charge (Annual percentage rate of 18%).
Late payments may result in temporary account closure.
Simple Abilities reserves the right to change terms to C.O.D. or Prepaid without notification.
Orders will be shipped C.O.D. or pre-paid pending credit approval.

Our Company/Organization is able to meet any commitments we make and will pay invoices and or /finance charges according to the terms outlined above.

Confirmation:
I agree to the terms and certify the above information to be correct.
Date:
Name:
Title:







All illustrations, photographs, and specifications within this website are based on the latest product information available at the time of publication. While we strive for accuracy, Simple Abilities reserves the right to make changes at any time, without notice, to prices, descriptions, images and policies. Products listed are registered trademarks of their respective manufacturers. Please take shipping time and costs into consideration. For additional company policy information, please select Customer Care & Resources.