BUSINESS DELIVERY SYSTEMS CREDIT ACCOUNT APPLICATION Click here for printable copy.
Date: __________________
Name of Firm: ___________________________________	Billing Address: __________________________________
Local Address: __________________________________	Attn: __________________________________________
City, State, Zip: __________________________________	City, State, Zip: __________________________________
Phone:_________________________________________	Phone:_________________________________________
Fax: ___________________________________________	Fax: ___________________________________________
Contact: _______________________________________	Contact: _______________________________________
Email Address: __________________________________	Email Address:___________________________________

Complete Appropriate Spaces:

Corporation Partnership Proprietorships Other ________________________________

Years in Business: ________________ D&B# : ___________________ Tax ID#: ___________________________________

President/CEO/Owner: ______________________________________________

Address: ______________________________________________

City, State, Zip ______________________________________________

V.P./Co-Owner: ______________________________________________

Address: ______________________________________________

City, State, Zip ______________________________________________

Business/Trade/Bank References:

Name Account Number Address/City/State/Zip Phone Contact

1. __________________________________________________________________________________________________

2. __________________________________________________________________________________________________

3. __________________________________________________________________________________________________

4. __________________________________________________________________________________________________

Amount of Credit Requested: $ _________________________

I (We) understand that the information furnished you on this page is for the purpose of obtaining business credit from your firm, that I am (we are) authorized, in my (our) capacity, to bind my (our) firm accordingly. That all accounts monies due you shall be payable at your place of business. That all past due accounts over thirty days, notes and/or judgments shall automatically draw interest at the rate of twenty-four percent (24%) per annum, with a $5 minimum charge monthly.

Our terms are net 10 days.

Name (Please Print) Title Signature

To get your account set up quickly, please fax completed and signed form to (972) 733-1645.