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CREDIT APPLICATION

This application must be completed for anyone wishing to apply for net terms. Completing this application does not guarantee credit terms with Advantage Emblem and Screen Printing.

Company Name and/or DBA:

Telephone Number:

Fax #:

Billing Address:

Billing City:

Billing State:

Billing County:

Billing Zip Code:

Primary Shipping Address:

Shipping City:

Shipping State:

Shipping County:

Shipping Zip Code:

The contact name of your Accounts Payable Person

A/P Contact Name:

Basic Company Information

Date Company Started:

Annual Sales Volume:

How much do you intend to spend monthly with Advantage Emblem?

Estimated Monthly Purchases:

Resale / Tax ID Number:

Employer ID #:

Federal Tax ID#:

Do you require the use of Purchase Orders?:

Yes

Business is a::

Corporation

Partnership

Proprietorship

Other (explain below)

If "Other" above, please explain::

Proprietor or one Principal's Name:

Home Phone:

Street Address:

City:

State:

Zip:

What is your main line of business?:

Banking References

Bank Name:

Bank Contact Name:

Bank Street Address:

Bank City:

Bank State:

Bank Zipcode:

Bank Phone Number:

Checking Account Number:

Savings Account Number:

Loan Number:

Date Account Opened:

Credit References

Supplier 1:

Supplier 1 Contact Name:

Supplier 1 Telephone:

Supplier 1 Address (PO Box/Street/City/St/Zip):

Supplier 2:

Supplier 2 Contact Name:

Supplier 2 Telephone:

Supplier 2 Address (PO Box/Street/City/St/Zip):

Supplier 3:

Supplier 3 Contact Name:

Supplier 3 Telephone:

Supplier 3 Address (PO Box/Street/City/St/Zip):

I hereby authorize Advantage Emblem and Screen Printing to request information from my bank and credit references.*

Full name of person completing this form.:

By entering the code below and submitting this form, I verify that I am the person listed above identified as filling out this form. Entering the code below and submitting the form constitutes a signature for the purposes of completing this form.

Please enter the code shown above in the box below:

Required