New Account Credit Application For fast credit approval please fax this form to: 763-746-2649 2700 Freeway Blvd. Ste. 500 Brooklyn Center, MN 55430 phone: 763-746-5100 fax: 763-746-2649
Bill To:
COMPANY NAME: ATTN: ADDRESS: CITY, ST, ZIP: PHONE: FAX: Type of Business: Products you will purchase:
Ship To:
COMPANY NAME: ATTN: ADDRESS: CITY, ST, ZIP: PHONE: FAX: Year established: Amount of credit requested:
FORM OF BUSINESS: __ Proprietorship __ Partnership __ Corporation (state: ______________)
PROPRIETOR, PARTNERS OR CORPORATE OFFICERS (Please provide an alternate address where we may reach you)
Name, title: Home Address: Name, title: Home Address:
SS# or FEIN#: Home phone #: SS# or FEIN#: Home phone #:
Ordering Information
Purchasing Agent: Accounts Payable Contact:
Are Written Purchase orders required? ___yes ___no
Is Merchandise for Resale? ___yes ___no Phone Phone
Resale No. Email: Email:
If for resale please include your ST3 Form
Fax Fax
Have you ever had credit with us before? ___no ___yes If yes, under what name______________________________
Invoices are mailed the following business day after shipment. Terms of credit will be credit card until credit references are checked, and then a credit limit is established. You will be responsible for material stocked per your request. An additional contract will need to be signed. The Applicant hereby represents and warrants that the information contained herein, or submitted in connection herewith, is true and complete as of the date hereof. The Applicant hereby authorizes Graphics Media to contact and investigate the references including banking information. Your submission of this credit application to Graphics Media for consideration is your acceptance of Graphics Media’s terms and conditions of sale along with Graphics Media’s credit and collection policies regarding late payments and account delinquency. Late charges are assessed if payment is not received within payment terms calculated from the invoice date/shipped date, If invoices are paid late Applicant agrees to pay a monthly service charge equal to one and one half (1-1/2%) or the maximum amount allowable under applicable state law of the unpaid delinquent balance until the account is paid in full. If the account is placed for collection, the applicant agrees to pay all costs and expenses of collection, including reasonable attorneys’ fees and expenses. Date Officer’s/Owner’s Signature Title
Business Credit References (can be submitted on separate paper, but please sign at bottom) Credit Information Release
BANK REFERENCE (fax # will expedite processing)
Bank Name _________________________________ Account# _____________________ Street Address _________________________________ City _________________________ State _____ Zip _________ Contact Name _________________________ phone _______________ fax ________________
TRADE REFERENCE (fax # will expedite processing)
Company Name _________________________________ Account# _____________________ Street Address _________________________________ City _________________________ State _____ Zip _________ Contact Name _________________________ phone _______________ fax ________________
TRADE REFERENCE (fax # will expedite processing)
Company Name _________________________________ Account# _____________________ Street Address _________________________________ City _________________________ State _____ Zip _________ Contact Name _________________________ phone _______________ fax ________________
TRADE REFERENCE (fax # will expedite processing)
Company Name _________________________________ Account# _____________________ Street Address _________________________________ City __________________________ State _____ Zip _________ Contact Name _________________________ phone _______________ fax ________________
I authorize my bank and all trade references listed on this application to release and/or verify credit information ________________________________________ Signed ________________________________________ Name __________________________ Date ___________________________ Title