Credit Application
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Company Information
Your Name:
Title:
Company Name:
Phone Number:	(              )	Fax Number:	(              )
Email Address:
Organization Type:	__ Corporation __ Sole Proprietorship __ Partnership __ Other
Year Established:		# Employees:
Tax Status:	__ Taxable __ Non-Taxable
Billing Address
Address1:
Address2:
City, State, Zip:
Shipping Address (leave blank if same as billing address)
Address1:
Address2:
City, State, Zip:
Credit Information
Credit/Trade Reference 1
Company Name:
Address:
City, State, Zip:
Phone Number:	(              )	Fax Number:	(              )
Email Address:		Account Type:
Credit/Trade Reference 2
Company Name:
Address:
City, State, Zip:
Phone Number:	(              )	Fax Number:	(              )
Email Address:		Account Type:
Credit/Trade Reference 3
Company Name:
Address:
City, State, Zip:
Phone Number:	(              )	Fax Number:	(              )
Email Address:		Account Type:
Bank Reference
Bank Name:
Address:
City, State, Zip:
Contact Name:		Phone Number:	(              )

By submitting this form, 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.

Authorized Signature: _____________________________________________ Date: ____________________