School Account Application Form

Organization / School Name *

School's Main Phone Number

Please enter a valid phone number.

Main Contact Name

Main Contact's Title

Main Contact's Phone Number

Please enter a valid phone number.

Main Contact's Email Address

example@example.com

Years in Operation *

Are you sponsored by a church? *

Yes No

Church Name *

Church Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Pastor's Name *

Pastor's Phone Number

Please enter a valid phone number.

Will the church pay if the school cannot? *

Yes No

How many students do you have enrolled or do you plan to have enrolled? *

What grade levels does your school have? *

When do you expect your school year to begin? *

How many days a week do you meet? *

Do you have a paid teacher(s)? *

Yes No

In what type of building are you located? *

School Church Home Other

Is your school/organization exempt from state sales and use tax? *

Yes No

Please upload a copy of your exemption certificate below.

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Is there any home-schooling or school umbrella group operating through your school/organization? *

Yes No

Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Delivery Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Is your delivery address residential or commercial? *

Residential Commercial

Years at this address *

Accounts Payable Contact Name *

First Name Last Name

Accounts Payable Phone Number *

Accounts Payable Email Address *

example@example.com

What type of payment option would you like to use?

I would like to prepay. I would like to apply for a line of credit with Apologia Educational Ministries, Inc.

Credit Reference #1

Credit Reference #1 Name *

Credit Reference #1 Account Number *

Credit Reference #1 Balance Owed *

Credit Reference #1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Credit Reference #1 Phone Number *

Please enter a valid phone number.

Credit Reference #2

Credit Reference #2 Name

Credit Reference #2 Account Number

Credit Reference #2 Balance Owed

Credit Reference #2 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Credit Reference #2 Phone Number

Please enter a valid phone number.

Credit Reference #3

Credit Reference #3 Name

Credit Reference #3 Account Number

Credit Reference #3 Balance Owed

Credit Reference #3 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Credit Reference #3 Phone Number

Please enter a valid phone number.

The above references may accept copies of this application as authorization to release credit or financial information on my account. I certify that all the information on this form is correct. If credit is granted, I understand that invoices are due and payable in full within 60 days of invoice date (any extension of terms must be approved in writing). I agree to pay all invoices promptly when due. I understand that all past-due balances will be assessed a late payment charge of 2% per month, or $10, whichever is greater, and that becoming delinquent will affect credit privileges. In the event payment is not made and my account is referred for collection, I will pay all costs of collection. Apologia Educational Ministries, Inc. is authorized to make all inquiries deemed necessary to determine credit worthiness of the undersigned, and the undersigned hereby authorizes all persons of whom you make such inquiries to respond thereto in full. I further understand that the information provided may be used to obtain a consumer credit report. I agree to all the terms and conditions of sale as defined in the Apologia Educational Ministries, Inc. school policy information.

I authorize the above creditors to release credit information for the purpose of establishing an account with Apologia Educational Ministries, Inc.

Full Name

First Name Last Name

Signature

Clear

School Account Application

School Information

Billing and Shipping Information

Accounts Payable Information

Payment

Credit Reference #1

Credit Reference #2

Credit Reference #3