Customer Information

Legal Name: 

Legal Form:

 Corporation

 Sole Proprietor

 Partnership

Business Type:   

Year Established: 

President / Owner / CEO:

Number of Employees:

- Please select one. -  

Annual Sales:

- Please select one. -  

PST # or State Tax #:

GST # or Fed.ID # / SSN #:

Bank Information

Bank Name: 

Bank Branch #: 

Bank Account #: 

Acct. Manager: 

Bank Phone: 

Bank Fax(opt): 

Bank E-mail(opt): 

3 Trade References

1.

Company Name: 

Contact: 

Phone: 

Extension (opt): 

Fax (opt): 

E-mail (opt): 

2.

Company Name: 

Contact: 

Phone: 

Extension (opt): 

Fax (opt): 

E-mail (opt): 

3.

Company Name: 

Contact: 

Phone: 

Extension (opt): 

Fax (opt): 

E-mail (opt): 

Authorization

I/We do hereby authorize Trade Secret Printing to verify all or part of the above listed confidential disclosures, and to verify the credit status of existing lines of credit as listed on this application. Further I/we agree to pay according to terms printed on any invoices for any purchase(s) including discounts, net price and late charges.

Value of First Order (est.):

Annual Purchases (est.):

Credit Limit Desired:

Terms Desired:

- Please select one. - 15 Days 30 Days 60 Days 90 Days  

Accounts Payable Contact:

Financial Statement Available?

 Yes          No    

Trade Secret Printing reserves the right to revoke/cancel credit status at their own discretion without prior notification.
By submitting this application I/we confirm that the above information is correct and I/we are authorized on behalf of the company to disclose the submitted information.

Name: First/Last