Rapid Supplies - Credit Application

APPLICATION
Full Legal Business Name :
Billing Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
Ship To Address :
City:
State:
Zip Code:
Telephone:
Fax :
Owner/President :
Social Security:
Applicant Type:
INDIVIDUAL PARTNERSHIP CORPORATION
Year:
Federal ID#:
UBA #:
DBA #:
Accounts Payable Contact:
Email Address:
Estimated Monthly Purchases:
Desired Credits:
Type of Product Requesting:
Your Name:
Title:
TRADE REFERENCES
Company Name:
Address:
Telephone:
City:
State:
Zip:
Contact Name:
Position:
Telephone:
Fax:
Acc #:
Company Name:
Address:
Telephone:
City:
State:
Zip:
Contact Name:
Position:
Telephone:
Fax:
Acc #:
BANK REFERENCES
Financial Institution:
Address:
City:
State:
Zip:
Bank Account #:
Contact Name:
Position:
Telephone:
Fax:
Please enter the following code into the box provided:

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 office-supplies.us.com within the terms of sale 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 30 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 suite fees, including a reasonable attorney's fee on the principal and service charges.