 . I N D E P E N D E N T . P R I N T I N G |
| Online Credit Application |
| . I N D E P E N D E N T . P R I N T I N G |
| Online Credit Application |
| This application must be on file before acceptance of work. | ||
| Company Name: | Phone: | |
| Contact Name: | Fax: | |
| Address: | Email: | |
| Suite/Dept.: | ||
| City: | State: Zip: | |
| Type of Entity: | Corporation Partnership | Individual |
| Years at Location: | ||
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| OFFICERS | ||
| Chief Operating Officer: | ||
| Title: | Phone: | |
| Financial Officer: | ||
| Title: | Phone: | |
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| FINANCIAL | ||
| Bank: | ||
| Address: | Phone: | |
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| CREDIT REFERENCES | ||
| Business 1: | ||
| Address: | Phone: | |
| Business 2: | ||
| Address: | Phone: | |
| Business 3: | ||
| Address: | Phone: | |
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| GENERAL | ||
| How did you hear about Independent Printing? | ||
| Printers with whom you are doing, or have done, business with on a credit basis: | ||
| Printer 1: | Phone: | |
| Printer 2: | Phone: | |
| Person(s) who are authorized to buy printing for your organization: | ||
| Authorized Name 1: | Phone: | |
| Authorized Name 2: | Phone: | |
| Do you require Purchase Orders? |
YES NO | |
| CREDIT CARD PURCHASES | ||
| Credit Card: | VISA MasterCard | American Express |
| Card Number: | Exp. Date: | |
| Full Name on Card: | ||
| By submitting this application, I certify that all information above is true and correct. | ||