PRINT-O-STAT, INC. Application for Open Account

For Location:
Company Name:   Phone:     
Customer's Street Address:   Fax:
P.O. Box:      City:    State:    Zip+4:
Company Web Site Address:      E-mail Address:
In Business Since:    Time at Present Location:    Number of Employees:
Type of Business: Taxable    Tax Exempt    (upon approval, will require tax exempt form)
SIC Code:  
Business Owned By:     Individual    Partnership    Corporation
If Partnership or Corporation, who are Partners of Partnership or Officers of Corporation:
1. Name: Title: Phone:
    Complete Adress:
2. Name: Title: Phone:
    Complete Adress:
3. Name: Title: Phone:
    Complete Adress:
Credit References
1. Name: Phone:
    Complete Address: Fax:
2. Name: Phone:
    Complete Address: Fax:
3. Name: Phone:
    Complete Address: Fax:
Bank Reference
    
Bank Name:     Phone:
Complete Address:
    
Contact:   Acct No:
Additional Information:
AMOUNT OF CREDIT DESIRED PER MONTH $ (Subject to Approval)
1. All open account terms are Net-30 days. Full payment for invoice amount is due 30-days from the date the invoice is issued.
2. A 1-1/2% (18% per anum) service charge will be assessed on all accounts that become past due.
3. All merchandise returns or invoicing disputes, including but not limited to quantity of items shipped, pricing adjustments, sales tax and freight overcharges, must be brought to our attention within thirty-days of invoice date. Any items on your account that have not been disputed within thirty days will be considered valid and collectable charges.
4. I understand that in signing this Application for Open Account, I am requesting that you establish open credit for our company and agree to pay all reasonable charges incurred by myself or my agent(s) in addition to any service charges incurred for past due balances, as are allowed under law.
5. In the event a collection procedure or lawsuit is instituted to recover possession of merchandise or to enforce any terms and conditions or provision hereof, I accept liability for service charges, legal fees, court costs and any other cost of collection in this matter, as allowed under law.
6. I am an authorized agent or representative of the above noted company and do hereby authorize PRINT-O-STAT INC, its agents or assignees to investigate and substantiate any statements made on this application for open credit.
Date:    (Applicant) By:    Title:
By clicking the submit button below, I agree to the terms and conditions of this application and certify that the facts contained are true and complete to the best of my knowledge.