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Credit Application
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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. |
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