Credit Application

Print, fill out and fax to: 402-895-2225

Company Name __________________________________________________

Phone # ______________________Fax #____________________________

Billing Address __________________________________________________

City ____________________________ State___________ Zip Code___________________

How long at your present location? ____________________

Shipping Address (if different then billing address):

Street Address_______________________________________________________________

City______________________________ State___________ Zip Code__________________

Is your company: Corporation_______ Partnership________ Individual_________

Are you tax-exempt? ___________

Tax ID #_________________________________

A/P Contact Name____________________________________________________________

Phone #_____________________________ Fax # _________________________________

Is a purchase order required? ____________ Approval from office? _____________

Name(s) of Officers or Partners:

Name_____________________________________ Title_____________________________

Name_____________________________________ Title_____________________________

Your bank and references:

Bank Name________________________________ Phone #___________________________

Address_____________________________________________________________________

City____________________________ State__________ Zip Code_____________________

Business References

Company Name_______________________________________________________________

Address_____________________________________________________________________

City______________________________ State _________ Zip Code___________________

Phone #____________________________ Fax #___________________________________


Company Name_______________________________________________________________

Address_____________________________________________________________________

City__________________________ State __________ Zip Code______________________

Phone #_________________________________ Fax #______________________________


Company Name________________________________________________________________

Address______________________________________________________________________

City__________________________ State __________ Zip Code_______________________

Phone #__________________________________ Fax #______________________________

Invoices are due and payable in full within 30 days of the invoice date. Any claims regarding an invoice must be made within 5 days of receiving product. A service charge not to exceed 1.5% a.p.r. per month may be assessed on all past due balances. Credit privileges may be withdrawn at TRP Inc.’s discretion. I (We) agree to the terms stated above and authorize TRP, Inc. to process credit inquiries on references provided above for the purpose of establishing credit with TRP, Inc.