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APPLICATION FOR CREDIT
*FIRM NAME
PHONE
FAX
BILLING ADDRESS
CITY
STATE
ZIP
SHIPPING ADDRESS
CITY
STATE
ZIP
PARENT CO. (IF APPLICABLE)
CITY
STATE
ZIP
BUYER CONTACT NAME
ACCOUNTS PAYABLE MANAGER CONTACT
TYPE OF BUSINESS:
Sole Proprietor
Partnership
Corporation
State of Incorporation
AGE OF BUSINESS
YEARS UNDER PRESENT OWNERSHIP
SALES TAX EXEMPTION #
CATEGORY OF BUSINESS
D & B#
TRADE REFERENCES - Please supply at least six
BANK REFERENCE
FULL ADDRESS
ACCT#
LOAN#
CONTACT NAME
PHONE
ESTIMATED ANNUAL PURCHASES
CREDIT LINE REQUESTED
PERMISSION TO SHIP ORDERS COD BEFORE REVIEW: YesNo
Enclosing your most recent financial statement can expedite processing
FINANCIAL STATEMENT
To be Mailed
Filed with D & B
Refused
We hereby certify that all statements in this application are true and complete and are made for the purpose of obtaining credit. We agree that all terms and conditions of sale will be complied with and all invoices paid within the terms indicated to prevent termination of credit. If not paid within terms, we agree to pay a late charge of 1 1/2% per month on the unpaid balance and to reimburse Corporate Image Promotion, Inc. or its affiliates all costs of collections, including legal fees.
*We give Corporate Image Promotion, Inc. or its affiliates permission to contact our bank reference and all trade references listed above to receive credit information upon request.
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