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©2005 MullenPublications.com

Customer Credit Application

 

The undersigned hereby applies for the extension of credit on open account from Mullen Publications, Inc., and agrees to MPI's Terms and Conditions of Sale, by supplying the following information:

 

Contact
Company
Address

City
State & Zip
Email address


Deliver material to: (if different from above)

Name
Address
City, State, Zip


Complete the following in full:

Corporation   Partnership   Individual
E.I.N. or
Social Security #:
Customer contact
Telephone
Business description
How long in business
Number of employees
Principals or Officers in Business:
Name 1
Address
Title
Name 2
Address
Title
Name 3
Address
Title
Who will be
responsible for debt
Is your company
tax-exempt?
Yes    No
If 'yes', it is MANDATORY that you fill out, sign and mail to us N.C. Dept. of Revenue Form E-590, Certificate of Resale.

Click here to download Form E-590.

If 'yes,'
tax emempt number:
Does your accounting department require a
purchase order number before processing invoices?
 
Yes    No
List three companies with whom you have established credit:
Name
Address
City, State & Zip
Phone
Name
Address
City, State & Zip
Phone
Name
Address
City, State & Zip
Phone

 

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