Credit Application

* Indicates a required field Company Information *Your Name: *Title: *Company Name: *Phone Number: *Fax Number: *Email Address: Organization Type: - select - Corporation Sole Proprietorship Partnership State Agency Federal Agency Other *Sales & Use Tax Status: Taxable Non-Taxable Year Established: Number of Employees: Billing Address Shipping Address (Leave blank if same as billing address) *Address1: Address2: *City: *State: - select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. *Zip Code: Address1: Address2: City: State: - select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. Zip Code: Credit Information Credit/Trade References 1. *Company Name: *Address: *City: *State: - select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. *Zip Code: *Phone Number: *Fax Number: Email Address: Type of Account: 2. *Company Name: *Address: *City: *State: - select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. *Zip Code: *Phone Number: *Fax Number: Email Address: Type of Account: 3. *Company Name: *Address: *City: *State: - select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. *Zip Code: *Phone Number: *Fax Number: Email Address: Type of Account: Bank Reference *Bank Name: *Address: *City: *State: - select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. *Zip Code: *Contact Name: *Phone Number: Agreement We warrant the information provided to be true. I, an authorized officer, grant permission to investigate the references, including commercial and consumer credit checks. I agree to pay MyOfficeProducts, Inc. within the terms of sale (net 20 days) and understand that a $25.00 service charge applies to all dishonored checks. A service charge of 18% per year will be imposed upon the accrued, unpaid balance of any bill not paid within 20 days. If the account is placed with an attorney, whether a lawsuit is filed or otherwise, or if any services are required to protect our interest, we agree to pay all costs and suit fees, including a reasonable attorney's fee on the principal and service charges. I agree