"Credit Application Form - Houchen Bindery"

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HOUCHEN BINDERY LTD.
340 First St. Utica, NE 68456
email@houchenbindery.com
Fax: 402-534-2761
CREDIT APPLICATION
GENERAL INFORMATION
PRINTING INDUSTRY REFERENCE
Legal Name________________________________
Name_____________________________________
DBA Name ________________________________
Phone____________________________________
Business Type______________________________
Address___________________________________
Street Address_____________________________
City______________________________________
City______________________________________
State________________________ Zip__________
State________________________ Zip__________
Fax______________________________________
Accounts Payable Contact____________________
OTHER TRADE REFERENCES
Mailing Address_____________________________
Name_____________________________________
City______________________________________
Phone____________________________________
State________________________ Zip__________
Address___________________________________
Phone____________________________________
City______________________________________
Fax______________________________________
State________________________ Zip__________
Email_____________________________________
Fax______________________________________
DUNS Number_____________________________
Type of Ownership:
Sole Proprietorship
Name_____________________________________
Sole Proprietorship
Partnership
Corporation
Phone____________________________________
Is sales tax applicable? ______________________
Address___________________________________
(If no, the attached resale certificate must be completed)
City______________________________________
Are purchase orders required? ________________
State________________________ Zip__________
BANK REFERENCE
Fax______________________________________
Name_____________________________________
Phone____________________________________
Name_____________________________________
Address___________________________________
Phone____________________________________
City______________________________________
Address___________________________________
State________________________ Zip__________
City______________________________________
Bank Officer_______________________________
State________________________ Zip__________
Authorized Release Signature
Fax______________________________________
_________________________________________
For the purpose of establishing credit with the creditor, the undersigned hereby authorizes any credit investigation necessary for
verification. I understand that (1) Payment terms will be stated on the invoice and we hereby agree to proper payment in consid-
eration of extended credit. (2) Seller reserves the right to access a service charge of 1.5% per month on accounts past due and to
collect all costs including a reasonable attorney’s fee if the account must be placed for collection. (3) The right to withdraw or
alter this credit privilege at any time is reserved. (4) All merchandise-services will be a cash basis until credit is approved. (5) Be
advised that material will not ship if there are unpaid invoices over 45 days. By means of the signature below, I certify that I am
authorized to apply credit on behalf of the above named firm or corporation and that all stated herein is true and accurate.
Signature: __________________________________________ Date:_____________
HOUCHEN BINDERY LTD.
340 First St. Utica, NE 68456
email@houchenbindery.com
Fax: 402-534-2761
CREDIT APPLICATION
GENERAL INFORMATION
PRINTING INDUSTRY REFERENCE
Legal Name________________________________
Name_____________________________________
DBA Name ________________________________
Phone____________________________________
Business Type______________________________
Address___________________________________
Street Address_____________________________
City______________________________________
City______________________________________
State________________________ Zip__________
State________________________ Zip__________
Fax______________________________________
Accounts Payable Contact____________________
OTHER TRADE REFERENCES
Mailing Address_____________________________
Name_____________________________________
City______________________________________
Phone____________________________________
State________________________ Zip__________
Address___________________________________
Phone____________________________________
City______________________________________
Fax______________________________________
State________________________ Zip__________
Email_____________________________________
Fax______________________________________
DUNS Number_____________________________
Type of Ownership:
Sole Proprietorship
Name_____________________________________
Sole Proprietorship
Partnership
Corporation
Phone____________________________________
Is sales tax applicable? ______________________
Address___________________________________
(If no, the attached resale certificate must be completed)
City______________________________________
Are purchase orders required? ________________
State________________________ Zip__________
BANK REFERENCE
Fax______________________________________
Name_____________________________________
Phone____________________________________
Name_____________________________________
Address___________________________________
Phone____________________________________
City______________________________________
Address___________________________________
State________________________ Zip__________
City______________________________________
Bank Officer_______________________________
State________________________ Zip__________
Authorized Release Signature
Fax______________________________________
_________________________________________
For the purpose of establishing credit with the creditor, the undersigned hereby authorizes any credit investigation necessary for
verification. I understand that (1) Payment terms will be stated on the invoice and we hereby agree to proper payment in consid-
eration of extended credit. (2) Seller reserves the right to access a service charge of 1.5% per month on accounts past due and to
collect all costs including a reasonable attorney’s fee if the account must be placed for collection. (3) The right to withdraw or
alter this credit privilege at any time is reserved. (4) All merchandise-services will be a cash basis until credit is approved. (5) Be
advised that material will not ship if there are unpaid invoices over 45 days. By means of the signature below, I certify that I am
authorized to apply credit on behalf of the above named firm or corporation and that all stated herein is true and accurate.
Signature: __________________________________________ Date:_____________