APPLY FOR CREDIT

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Company Name:..

Address:..

City / State / Zip:..

Fed ID#:..

Phone Number:..

Fax Number:..

E-Mail Address:..

Billing Information

Company Name:..

Mailing Address:..

City / State / Zip:..

Phone Number:..

Fax Number:..

Contact Person:..

Business Type:..

Sole Proprietorship

Partnership

Corporation ..in the state of:

No. of Yrs. in Business:..

Dunn & Bradstreet No.:..

Name and address of individuals, partners, or officers.:..

Name:..

Title:..

Address:..

Phone:..

Name of person regarding purchase orders and invoice payments.:..

Name:..

Title:..

Address:..

Phone:..

Bank Reference:..

Bank:..

Account No.:..

Bank Contact:..

Phone:..

Three Trade References:..

Company:..

Full Address:..

Contact Person:..

Phone:..

Fax:..

Company:..

Full Address:..

Contact Person:..

Phone:..

Fax:..

Company:..

Full Address:..

Contact Person:..

Phone:..

Fax:..

The above information is herewith submitted for the purpose of opening an account and I do hereby certify this information to be true. I also understand the credit terms to be net 30 days and agree to pay within in these terms. All invoices over 30 days will be charged 1 1/2% per month, 18% apr.

Submitted By:..

Title:..

LOCATION & DIRECTIONS | PHONE: 1-800-682-8233

Locally Owned & Locally Operated

226 West 8th Street • Greenville, NC 27834
phone: (800) 682-8233 • fax: (
252) 758-1984
Mastercard, Visa, Discover and American Express Accepted.
© 2011 Taff Office Equipment Company. All Rights Reserved.