Business Name: Business Name* Sales Representative Sales Rep*Phone: Area Code Phone Number Address: Street Address Address Line 2 City State Zip Owner's Name: Owner's Name Number of Employees: Number of Employees Business Email Address: Business Email Address Contact Person in Purchasing: Contact Person in Purchasing
Electronic Invoicing Information (choose one)Email: Email Fax Number: Area Code Phone Number
Type of business: Type of business SIC Code: SIC CodeNature of Business: Nature of Business Number of years: Number of years
Bank Reference: Business Name Phone: Area Code Phone Number Address: Street Address Address Line 2 City State Zip Checking Account Number: Checking Account Bank Manager / Loan Officer:
Please list THREE Credit References other than banks.
I the undersigned, hereby state the information listed on this application to be accurate to the best of my knowledge. I give my consent and authority to NICHOLS PAPER & SUPPLY CO. to investigate and verify the information provided. All new accounts will be C.O.D. until credit is approved. If open account is granted PAYMENT TERMS ARE NET 25 DAYS. If open account terms are granted, in the event of non-payment according to the terms stated above, I agree to pay a 1½% per month (18% per annum) interest charge up to the maximum amount allowable by law. If I agree to pay by credit card a 3% fee will be assess on all orders. If outside services are required to collect payment on account, I agree to pay all collection costs including but not limited to collection fees, court costs and attorney fees, up to the maximum allowable by law. I have read, understand, and agree to the above stated terms.
Title: Date: Date