mg10.21.09.002
Net 30 – Application Letter
Thank you for your interest in an open line of credit with Core Integrated Marketing. Upon approval, the terms
of sale will be 2%10 Net 30 Days.
Prior to approval, it is necessary that you complete the attached application in its entirety.
Please check to ensure that the application is signed by the Owner or a Corporate Officer and return to:
Core Integrated Marketing
209 Glenwood Road
Chicago Heights, IL 60611
708.756.1120 ph
708.756.2946 fx
After your application is received, your credit will be evaluated. Please allow a minimum of 10 working days
for determination of your Credit Line. Merely complying with the above does not guarantee credit approval. You
will be notified in writing of approval.
mg10.21.09.002
Net 30 Credit Application
PLEASE COMPLETE IN FULL – INCOMPLETE AND/OR INACCURATE APPLICAIONS MAY DELAY PROCESSING.
Customer Number _________________
Company Information
Company Name _____________________________________________
Billing Address ______________________________________________
Shipping Address ____________________________________________
City ____________________ State _________ Zip _________________
Phone ( ) __________________ Fax ( ) ___________________
D/B/A _____________________________________________________
Former Business Address (If less than 5 yrs) ______________________
__________________________________________________________
Name of Landlord if Building not owned __________________________
Address/ Phone number _______________________/_______________
Federal I.D. ______________ Certificate of resell #_______________
Type of Business _______________ Date Established ______________
Email Address ______________________________________________
Does State, County, or City Require a License? YES NO
(Attach copy of original)
No. Of Employees _____ Est. Annual Sales $ _____________________
A/P Contact ________________________________________________
If Yes License #_____________________________________
Legal Status (circle one)
Sole Proprietor Partnership Corporation Parent Company (if applicable) ______________________
Principals
Principal: ________________________________________________________________________________________
(Name) (Title) (Home Address/Tel.)
Principal: _________________________________________________________________________________________
(Name) (Title) (Home Address/Tel.)
Trade/ Vendor References
(References supplying product or services who have granted credit terms. Do not list utilities or personal references.)
Firm Name Phone # Fax # Email Address
Payment
Terms
Bank Information
____________________ _____________________________________________ _________________________________
(Bank Name) (Street Address) (City/State/Zip Code)
mg10.21.09.002
_________________________ ______________________________ ______________________________________________
(Account#) (Contact Name) (Tel./Fax.)
Billing Options
Please email all invoices in lieu of paper invoices Please email all statements in lieu of paper statements
Email Address (if different from above) ______________________________________________
Type of Credit Agreement
Customer agrees to Credit Terms; payment on receipt, but no longer than 30 days.
Outstanding past due balances are subject to 1 ½ % per month interest.
Applicant agrees to pay any collection costs incurred to collect the account balance, including court costs, collection fees and attorney’s fees of not less
than 33% of the unpaid principal, plus interest. As an inducement to grant credit, the undersigned agrees to the need for verification of all business
information on this application and authorizes, and releases all banks, businesses and persons identified on this application to furnish any and all
information requested by Core Integrated or its representative, by telephone or written correspondence whichever Core Integrated requests. The
undersigned warrants that the information is true and correct.
X ________________________________________ X __________________________________________________
(Name of Business) (Signature)
X ________________________________________ X __________________________________________________
(Print Name) (Title)
_____________________________________________________
PERSONAL GUARANTEE
Personal Guarantee
The undersigned in consideration for the extension of credit to said applicant, hereby agrees to the above terms and conditions and to personally
guarantee all liabilities and responsibilities for payment of the corporation’s account and further guarantees payment of any monies that become due in
accordance with the above terms and conditions
.
X_______________________________________ ___________________
Signature Date
___________________________________
Print Name
_______________________________________________
Home address
_______________________________________________
Home Phone number
FOR OFFICE USE ONLY:
CREDIT LIMIT APPROVED BY DATE
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