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:
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How did you find us? ____________________________
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Company Name:
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DBA _________________________________________
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Phone Number:
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Fax Number: Acct #:
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Street:
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P.O. Box ____________________________________
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City:
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State: Zip: County:
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Form Of Ownership: Proprietorship _______ Partnership _______ Corporation ________ Non-Profit _______
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Sales Tax # _________________ State______ FID # _______________ State of Incorporation ______________
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Credit Limit Requested $________________ Year Business Started ___________ No. Of Employees __________
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Principal Owner or Officers of Company, and Title:
_____________________________________________________________________________________________
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_____________________________________________________________________________________________
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Accounts Payable Contact/Phone/Email______________________________________________________________
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BANK REFERENCE
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Principal Bank ___________________________ Acct # ____________________ Phone #____________________
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Street ________________________________________________________ Fax # _________________________
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City ________________________________________
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State ______________________ Zip ______________
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TRADE REFERENCES
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Name _______________________
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Name _______________________
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Name _______________________
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Address _____________________
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Address _____________________
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Address _____________________
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City _________________________
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City _________________________
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City _________________________
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State/Zip _____________________
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State/Zip _____________________
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State/Zip_____________________
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Phone #______________________
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Phone #______________________
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Phone # _____________________
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Fax # _______________________
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Fax # _______________________
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Fax # _______________________
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Acct. # ______________________
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Acct. # ______________________
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Acct. # ______________________
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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.
_______________________________________
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____________________________________
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Owner/Partner/President Signature:
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Date:
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