Please print out this application and be as detailed as possible with your answers. When you are finished simply sign and date it then fax it back to us at: 1-810-748-9101. Please allow 3 to 5 business days for our credit department to process your request.
Legal Business Name Date Established Phone ____________________________________________________________________________________________ DBA ____________________________________________________________________________________________ Billing Address City State Zip ____________________________________________________________________________________________ Owner/President Treasurer ____________________________________________________________________________________________ Vice President Controller ____________________________________________________________________________________________ [ ]Corporation [ ]Limited Partnership [ ]General Partnership ____________________________________________________________________________________________ Parent Company Does Parent Company Guarantee Debts? ____________________________________________________________________________________________ Address City State Zip ____________________________________________________________________________________________ Type Of Business # Of Employees Acct. Pay Contact ____________________________________________________________________________________________
Checking: Name Branch Phone Account# Cnct ____________________________________________________________________________________________ Address City State Zip ____________________________________________________________________________________________ Loan Name Branch Phone Account# Cnct ____________________________________________________________________________________________ Address City State Zip ____________________________________________________________________________________________ Assets Pledged? With Whom? ____________________________________________________________________________________________
Name Phone Account# ____________________________________________________________________________________________ Address City State Zip ____________________________________________________________________________________________ Name Phone Account# ____________________________________________________________________________________________ Address City State Zip ____________________________________________________________________________________________ Name Phone Account# ____________________________________________________________________________________________ Address City State Zip ____________________________________________________________________________________________
Our Standard payment terms is Cashiers Check for all new accounts. All other related terms and conditions are defined in our invoice. I / We understand and agree that the information provided is for the purpose of opening an account with LOCAL ONLINE. I /We furthur understand and agree that all accounts or money due to LOCAL ONLINE shall be paid in accordance with the payment terms stated above and agree to pay all reasonable costs of collection. In addition to any court costs and / or attorney feea incurred. I / We authorize investigation of all credit references listed.
By:___________________________________Title:_______________________Date:_______________________