PLEASE FILL OUT COMPLETELY AND SIGN TO ESTABLISH NET 30 DAY TERMS
Desired Credit Limit

COMPANY NAME:

d/b/a:

Bill to Address

Street Address

City/State

Owners(s)/President

Accts. Payable Contact

AP Phone & Fax #

AP E-mail Address

Banking Institution

Acct. Numbers
Contact
Phone & Fax #'s
Years in Business
Dunn & Bradstreet #
Annual Sales
Net Worth
Number of Employees
Federal Tax ID #
*Please attach reseller' certificate*
Company Structure Sole Proprietorship Corporation State Partnership LLC
T R A D E R E F E R E N C E S 
NAME OF COMPANY:
CONTACT:
CITY STATE
PHONE:
   
NAME OF COMPANY:
CONTACT:
CITY STATE
PHONE:
   
NAME OF COMPANY:
CONTACT:
CITY STATE
PHONE:
I authorize the release of the above information to Springfield Blue Print & Photo Copy Co. for credit purposes only.  In order for Springfield Blue Print & Photo Copy Co. 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 will 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 the above is true and terms are accepted.
Print Officer's Name
Officer's Signature
Officer's Title
Date Wednesday, June 19, 2013
 
 
Head Office
219 E. Pershing Springfield, MO 65806
E-Mail: info@spfdblue.com

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