Customer Credit Application

Please fill out this for m completely, print, sign and fax to 432.682.9188 to make a request to establish net 30 day terms
   
Desired Credit Limit
   
Corporate Info  
Company Name
D/B/A
Owner(s)/President
   
Years in Business
Type of Entity
Annual Sales
Net Worth
Number of Employees
Federal Tax ID
   
Billing Address
     City, State, ZIP ,
Street Address
     City, State, ZIP ,
   
Accounts Payable Info  
Accounts Payable Contact
     Phone
     Fax
     E-Mail
   
Banking Info  
Banking Institution
Account Number
Contact
     Phone
     Fax
   
Trade References  

     Two industry trade references required
  Industry Reference Industry Reference Trade Reference
Business Name
Account Number
Annual Purchases ($)
       
Contact
     Phone
     Fax
       
       

I authorize the release of the above information to Printer Solutions for credit purposes only.  In order for Printer Solutions to grant me credit, I give permission for my credit to be checked as required for that purpose.  Credit terms are net thirty (30) days from the date of invoice.  Interest may be charged at 1.5% per month on items over thirty (30) days.  If my account is referred for collection, I agree to pay all billing and collection costs and a reasonable attorney's fee.  All of the above is true and terms are accepted.

Officer's Signature _____________________________
Officer's Name
Officer's Title
Date