PEARSON CREDIT APPLICATION AND ACCOUNT INFORMATION FORM

CREDIT APPLICATION AND ACCOUNT SETUP REQUEST
Business/Organization Information
Business/Organization Name
What type of business/organization is this?*

CorporationPartnershipIndividually OwnedGovernment (Federal, state, county, city agency)Non-Government Organization (Industry Trade Association, Vol. Fire & Rescue, non-profit organizations, etc.)Public University/College
Billing/Mailing Address: (This address must match the information shown on the documents provided for business verification).*

Street Address

Street Address Line 2

CityState

Zip Code
Is the billing/mailing address a PO Box?

YesNo
Business Phone:*
Please enter a valid phone number.
Business Fax
Please enter a valid phone number.
Website:

Primary Contact Information

The primary contact is the person that will be contacted when information is required such as account activity, authorized purchasers, billing questions, etc.
Name of primary contact*

First NameLast Name
Primary Contact (text field)
Email address of primary contact*

Confirmation Emailexample@example.com
Phone number of primary contact*
Please enter a valid phone number.
Is the business/organization exempt from paying sales taxes?*

YESNO
Please upload a copy of your sales tax exemption certificate otherwise sales tax will be applied to all invoices.*

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Please upload a copy of your business license/permit, contractor license, charter, or other document to verify current business operation. This documentation must show the same billing address.*

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Accounts Payable and Purchasing Information
Does your business use/require purchase orders?*

YESNO
What is the name of the person that should receive the invoices and statements for this account?*

First NameLast Name
Accounts Payable Full Name
What is the email(s) of the person or department that will receive the invoices and statements for this account? (Please separate addresses with a comma.)
example@example.com
What is the phone number of the person or department that will receive invoices and statements for this account?*
Please enter a valid phone number.
What is the fax number of the person or department that will receive invoices and statements?
Please enter a valid phone number.
CREDIT LINE REQUESTED ($):
The basic line of credit is $5000. Credit requests greater than $5000 require credit and trade references.

Identification of business principals

Only required for accounts requesting a credit line greater than $5000
Principal #1 Full Name
Principal #1 Home Address
SSN of Principal #1
Principal #2 Full Name
Principal #2 Home Address
SSN of Principal #2
Principal #3 Full Name
Principal #3 Home Address
SSN of Principal #3

Bank and Trade References:

This section is required if credit line requested is greater than $5000
Name of Bank:
Bank Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Phone Number:
Please enter a valid phone number.
Bank Contact Name
Bank Account #1
Bank Account #2
NAME OF THREE MAJOR SUPPLIERS FROM WHOM CREDIT IS OBTAINED:
SUPPLIER #1 NAME:
SUPPLIER #1 ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SUPPLIER #1 PHONE NUMBER
Please enter a valid phone number.
SUPPLIER #1 ACCOUNT NUMBER
SUPPLIER #2 NAME:
SUPPLIER #2 ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SUPPLIER #2 PHONE NUMBER
Please enter a valid phone number.
SUPPLIER #2 ACCOUNT NUMBER
SUPPLIER #3 NAME:
SUPPLIER #3 ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SUPPLIER #3 PHONE NUMBER
Please enter a valid phone number.
SUPPLIER #3 ACCOUNT NUMBER
PLEASE ATTACH A COPY OF RECENT FINANCIALS. This only applies when requesting a credit line greater than $10,000.

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Initial Order Information
Do you want to place an order or receive a written quote first?*

Place order nowSend a written price quote first
What is the purchase order or reference for this order/quote?
If no PO is used, please enter your last name and date as MMDDYYYY(For example, JONES05252022)
Do you want to upload your order information or enter the product data directly on this form?*

I want to upload my order informationI want to enter the product information here
Please upload your order information*

Acceptable file types are xls, xlsx, pdf, doc, docx, csv, txt, rtf
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Item 1:Please enter ISBN-13 (no dashes) of the product requested*
All Pearson ISBNs begin with 978013
Quantity requested*
Title or product description*
Who is the author of the title?
Providing the title helps to verify the correct product is being ordered.
Do you want to add additional products?*

YesNo

INITIAL ORDER: ITEM 2
Item 2: Please enter the ISBN-13 (no dashes) of the product requested*
All Pearson ISBNs begin with 978013
Quantity requested*
Title or product description*
Who is the author of the title?
Providing the title helps to verify the correct product is being ordered.
Do you want to add additional products?*

YesNo

INITIAL ORDER: ITEM 3
Item 3: Please enter the ISBN-13 (no dashes) of the product requested*
All Pearson ISBNs begin with 978013
Quantity requested*
Title or product description*
Who is the author of the title?
Providing the title helps to verify the correct product is being ordered.
Do you want to add additional products?*

YesNo

INITIAL ORDER: ITEM 4
Item 4: Please enter the ISBN-13 (no dashes) of the product requested*
All Pearson ISBNs begin with 978013
Quantity requested*
Title or product description*
Who is the author of the title?
Providing the title helps to verify the correct product is being ordered.
Do you want to add additional products?*

YesNo

INITIAL ORDER: ITEM 5
Item 5: Please enter the ISBN-13 (no dashes) of the product requested*
All Pearson ISBNs begin with 978013
Quantity requested*
Title or product description*
Who is the author of the title?
Providing the title helps to verify the correct product is being ordered.

Acknowledement and Agreement to Terms and Conditions
Should Pearson Education engage a collection agency and/or attorney-at-law to collect any outstanding balance upon default of this account, the undersigned hereby agrees to pay the principal indebtedness, interest thereon, and reasonable collection/attorney fees. The undersigned acknowledges that Pearson Education is under no obligation to extend credit to this account or, if credit is extended, to continue to extend such credit.
The undersigned further acknowledges that they have read, understand, and agree to Pearson Education’s Terms & Conditions of Sale. This serves as authorization for Pearson Education to review the information contained in this application and authorizes the undersigned’s bank and trade references listed above to release necessary information for credit approval.*

Clear
Signed by*

First NameLast Name
Title
Date*

MonthDayYear
Date