Johnson Printing Credit Application

GENERAL Company Name E-Mail Phone Fax Street Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY A/P Contact Phone Purchasing Contact    Purchase Order Required  Yes No      Type of Business        How Long in Business  Names and Titles of Principals     1--           2--           3-- Please check one     Individual       Sole Proprietorship       Partnership       Corporation Tax ID #     Previous Business Name     Date of most recent financial statement Dun & Bradstreet rated?    Yes No          Rating TRADE REFERENCES   Name Street Address City State Contact Phone Fax 1- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY 2- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY 3- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY 4- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY BANK REFERENCES Name of Bank Street Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip Code Contact Name Account Number Phone Exempt from Sales Tax? Yes No Resale Number State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY City         Please furnish copy of exemption letter from the State Dept. of Revenue   TERMS ACCOUNTS ARE DUE AND PAYABLE WITHIN 30 DAYS FROM BILLING DATE. PAST DUE ACCOUNTS ARE SUBJECT TO A FINANCE CHARGE AT THE RATE OF 1.5% PER MONTH (AN ANNUAL RATE OF 18%). APPLICANT AGREES TO PAY ALL COLLECTION COST INCLUDING REASONABLE ATTORNEY FEES IF ACCOUNT MUST BE COLLECTED BY SUIT OR OTHERWISE.   Date Title   JP Sales Contact     Select One Rudy DeSousa Laurie Hedger Bob Kent Robin Powers Lindalee Schwinnen Ken Sherod Greg Walz Jason Wright Not Sure               Johnson Printing 1880 South 57th Court Boulder, Colorado 80301 (800) 824-5505  (303) 443-1576   FAX (303) 998-7590   www.jpcolorado.com A DIVISION OF JOHNSON PUBLISHING COMPANY