Office-Supplies.us.com - Credit Application

APPLICATION

Full Legal Business Name :

Billing Address:

City:

State:

Zip Code:

Phone Number:

Email Address:

Ship To Address :

City:

State:

Zip Code:

Telephone:

Fax :

Owner/President :

Social Security:

Applicant Type:

INDIVIDUAL

PARTNERSHIP

CORPORATION

Year:

Federal ID#:

UBA #:

DBA #:

Accounts Payable Contact:

Email Address:

Estimated Monthly Purchases:

Desired Credits:

Type of Product Requesting:

Your Name:

Title:

TRADE REFERENCES

Company Name:

Address:

Telephone:

City:

State:

Zip:

Contact Name:

Position:

Telephone:

Fax:

Acc #:

Company Name:

Address:

Telephone:

City:

State:

Zip:

Contact Name:

Position:

Telephone:

Fax:

Acc #:

BANK REFERENCES

Financial Institution:

Address:

City:

State:

Zip:

Bank Account #:

Contact Name:

Position:

Telephone:

Fax:

We warrant the information provided to be true. I, an authorized officer, grant permission to investigate the references, including commercial and consumer credit checks. I agree to pay office-supplies.us.com within the terms of sale and understand that a $25.00 service charge applies to all dishonored checks. A service charge of 18% per year will be imposed upon the accrued, unpaid balance of any bill not paid within 30 days. If the account is placed with an attorney, whether a lawsuit is filed or otherwise. Or if any services are required to protect our interest, we agree to pay all costs and suite fees, including a reasonable attorney�s fee on the principal and service charges.