All fields with (*) must be filled out.  All information will be kept in strict confidence. 
Click here to fill out this form on-line using secure server.
You can print out this page, fill it out and fax to 800.327.7570

FILL OUT BY

* Name of Firm or Individual:

* Account#:      * Phone:       Email:

* Street Address 1:      Street Address 2:

* City: * State: * ZIP:       * Years at this address:

OWNERSHIP

* Corporation   Incorporated within last 12 months   Partnership   Individual

Name(s) of Principal(s): (Last name, First name) (At least one principal must be provided)

* 1.   2.   3.   4.

   5.   6.   7.   8.

* Gross Sales: $       * Number of Employees:

* How Long in Business: years and months

BANK INFORMATION

* Bank:             * Bank Officer Department:    

* Bank Address:      * City:      * State:      * ZIP:

* Phone:      Fax:      * Account#:     

* Doing Business Since(dd/mm/yyyy):

* Average Bank Balance: $

* Loans? Yes No          If yes, they are: Secured Unsecured

* Satisfactory: Yes No

Any Comments? 

REFERENCES

1.

2.

Envelopes & More TERMS:

• First Order C.O.D. or Prepaid

• Normal Credit Terms Net 15 Days

• Tax Exempt Certificate must accompany FIRST ORDER.

I certify that all the information on this form is correct.  I fully understand your credit terms and agree to the proper payment in consideration of extended credit.