Credit Application

Accurate Office Supply 260 Gerzevske Lane Carol Stream, IL 60188 (630) 784-4700 FAX (630) 784-4747

CREDIT APPLICATION

COMPANY NAME:
BILLING ADDRESS:
Address 1:
Address 2:
City:
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SHIPPING ADDRESS:
Address 1:
Address 2:
City:
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  Zip:
PHONE:
FAX:
EMAIL:
YEARS AT THIS ADDRESS:
NUMBER OF EMPLOYEES?
ARE YOU TAX EXEMPT?
TAX EXEMPT NO:
IS A PO REQUIRED?
CONTACT NAME FOR ACCOUNT PAYABLE:
LIST ALL AUTHORIZED TO PURCHASE:
PRINCIPALS OF COMPANY/ COMPLETE ADDRESS & PHONE:
FINANCIAL INFO:
Bank Name & Address
Bank Officer OR Dept:
Phone #:
CREDIT REFERENCES: (Please provide Business name, address & phone number)
SIGNATURE:
TITLE:
Unless negotiated otherwise, payment terms are NET 30 DAYS FROM DATE OF THE INVOICE. Invoices are sent with delivery of goods and statements are mailed the first working day of each month. A 1.5% per month finance charge is added to all past due balances
FOR ACCURATE OFFICE SUPPLY USE ONLY:

Program:	Credit Limit: $	Account #
Salesman #:	Website ID:	Website Password: