Application for Business Credit

Application for Business Credit

All information below is required to establish terms. Please allow 3-5 business days for your credit to be available. Contact us with any questions at (800) 234-6605.
Date of Application*

MonthDayYear
Name of Firm*
Phone*
Fax
Billing Address*
Billing City*
Billing State*
Billing Zip*
Shipping Address*
Shipping City*
Shipping State*
Shipping Zip*
Business Type:

Sole ProprietorshipPartnershipCorporation
State & Date Incorporated
Name of President, Partners or Owners
Phone
Tax Status*

TaxableNon-Taxable
If non-taxable, please attach a copy of your Tax-Exempt Certificate.

Cancelof
Accounts Payable Contact*
Accounts Payable Phone*
Accounts Payable E-Mail Address*
example@example.com
Email Address to send Monthly Statements*
example@example.com
Are Purchase Orders Required?

YesNo
Number of Employees in Company
Preferred Website Username (password will be assigned and you can change it after you login)

Bank References*

	Bank Name	Bank Officer to Contact	Address - City, State, Zip	Telephone / Fax

Business References (3 Required)*

I (We) understand that the information furnished on this page is for the purpose of obtaining business credit from Perry Office Plus, and do hereby authorize the above entities to release the credit reference information requested for such purposes. I am (we are) authorized, in my (our) capacity, to bind my (our) firm accordingly. All accounts or monies due Perry Office Plus shall be th due and payable at your place of business no later than the (10) day of the month following the date of the invoice.
Print Name*
Signature*

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Print Name
Signature

Clear
Should be Empty: