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Online Credit Application Form for Net 30 Terms

Acceptance Required

Applicant agrees to pay any collection costs incurred in collecting their account balance, including reasonable attorney fees and service/interest charges. The undersigned acknowledges that they have not withheld any information that may affect their ability to meet their obligation in a timely manner and warrants that the information submitted is true and correct. Authorization is given to release all requested credit information to Integrity Toner.

Business Structure
Legal Business Name
DBA
Name of Owner/President
Primary Contact First Name
Primary Contact Last name
Bill to Address
Bill to City
Bill to State
Bill to Zip
Business Phone #
Business Fax #
Accounts Payable Phone #
Accounts Payable Fax #
Accounts Payable e-mail
Name of Person Authorized to Order 1
Name of Person Authorized to Order 2
Name of Person Authorized to Order 3
Years In Business
Federal ID #

Line of Credit Requested
Vendor Name
Account #
Phone #
Fax #
Street Address
City
State
Zip
Vendor Name
Account #
Phone #
Fax #
Street Address
City
State
Zip
I Accept (see above)
Name
Title