Credit Application

Business Contact Information:

Company:

Registered Company Address:

City / State / Zip:

Contact:

Phone:

E-Mail:

Sole Proprietorship

Partnership

Corporation

Other

Business Information:

Primary Business Address:

City / State / Zip:

How long at current address:

Phone:

Fax:

E-Mail:

Business / Trade References: Required for (Net Terms)

Company:

Account Type:

Company Address:

Contact:

Phone:

E-Mail:

Company:

Account Type:

Company Address:

Contact:

Phone:

E-Mail:

Credit Card Information:

Visa
Master Card
American Express
Discover

Card Number:

Expiration Date:

Security Code:

Billing Address:

Address:

City / State / Zip:

Phone:

E-Mail:

By signing below and submitting for payment, | acknowledge acceptance the issuers of the terms and conditions. | also agree to waive any charge-backrights. In the event of a dispute or refund request,| will contact USColorworks directly at 888-710-0488 and will submit all order documentation in accordance with standard policy of companyissuing credit card.

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I understand and authorize that my first order will be charged to the credit card referenced above.

I also understand and authorize that all future invoices on payment terms that are past due more than 7 days may be charged to the card on file.

Agreement:

1) All invoices art to be paid 30 days from the date of invoice. Any late payments may be charged using the credit card on file.
2) Claims arising from invoices must be made within seven working days.
3) By submitting this application you authorize USColorworks and to make inquiries into the refrence that you have supplied.

Signature:

Date:

Printed Name....

Title....

This form must be completed in full and all information must be true and correct in order for your payment to be processed.

Please email completed form to [email protected]

FOR INTERNAL USE ONLY: INFORMATION ON THIS FORM MUST BE KEPT IN A SECURE LOCATION AT ALL TIMES. DO NOT TRANSFER OR TRANSPORT WITHOUT PRIOR AUTHORIZATION. DESTROY PROMPTLY BY SHREDDING WHEN NO LONGER NEEDED.

Business Contact Information:

Business Information:

Business / Trade References: Required for (Net Terms)

Credit Card Information:

Billing Address:

Agreement:

Printed Name....

Title....

This form must be completed in full and all information must be true and correct in order for your payment to be processed.

Please email completed form to [email protected]

[email protected]

4910 Starcrest Drive. Monroe, NC 28110 TOLL FREE 888.710.0488 LOCAL 704.288.2275

4910 Starcrest Drive. Monroe, NC 28110
TOLL FREE 888.710.0488 LOCAL 704.288.2275