Credit Application
Any first time order over $300.00, must fill out our credit application.
Please copy and paste the application below into any word processor program.
Complete the entire form.
Scan and email to sales@northcoastink.com.
We cannot process your order till this procedure is finished.


Credit Application
Date:
How did you find us? ____________________________

Company Name:
DBA  _________________________________________
Phone Number:
Fax Number:               Acct #:     
Street:  
P.O. Box ____________________________________
City:       
State:            Zip:          County:

Form Of Ownership:   Proprietorship _______     Partnership _______     Corporation ________    Non-Profit _______

Sales Tax # _________________ State______    FID # _______________  State of Incorporation  ______________

Credit Limit Requested $________________    Year Business Started ___________   No. Of Employees __________

Principal Owner or Officers of Company, and Title:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Accounts Payable Contact/Phone/Email______________________________________________________________

BANK REFERENCE

Principal Bank ___________________________ Acct # ____________________   Phone #____________________

Street ________________________________________________________    Fax # _________________________
City  ________________________________________
State  ______________________  Zip  ______________
TRADE REFERENCES
Name _______________________
Name _______________________
Name _______________________
Address  _____________________
Address  _____________________
Address  _____________________
City _________________________
City _________________________
City _________________________
State/Zip _____________________
State/Zip _____________________
State/Zip_____________________
Phone #______________________
Phone #______________________
Phone # _____________________
Fax # _______________________
Fax # _______________________
Fax # _______________________
Acct. # ______________________
Acct. # ______________________
Acct. # ______________________

Applicant agrees to pay any collection costs incurred to collect the amount balance, including reasonable attorney's fees. Applicant also agrees to pay 3% per month service charge for accounts over thirty days old.

The undersigned as an inducement to grant credit warrants that the information submitted is true and correct.  North Coast Ink Supply is authorized to investigate the credit references listed above. Application will not be processed without signature.
_______________________________________
____________________________________
Owner/Partner/President Signature:
Date:


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