NonstopDelivery - Credit Application

CREDIT APPLICATION
Please click here to download the credit application or fill out the form below.

Date:	DUNS#:
Legal Business Name:
Trade Name:
Address:
City:
State:	Zipcode:
Business Contact:
Email:
Telephone:	() -
Fax:	() -

Billing Address:
City:
State:	Zipcode:
Billing Contact:
Email:
Telephone:	() -
Fax:	() -
Corporation Sole Proprietor Partnership Other
Federal Tax Id Number:	Year Established:
Annual Revenue (may require financial statement):
Billing Reference Required: Yes No If Yes, Description:


Bank Reference:
The undersigned hereby authorizes the following credit reference to disclose all details necessary to enable NonstopDelivery to establish an open account.

Company Bank:	Account Number:
Billing Address:
City:
State:	Zipcode:
Phone:	() -
Contact:

Business References (must have approved credit for at least the minimum amount requested from NonstopDelivery):
Company #1:
Phone:	() - Account #:
Billing Address:
City:
State:	Zipcode:

Company #1:
Phone:	() - Account #:
Billing Address:
City:
State:	Zipcode:

Terms: Due Upon Receipt
In consideration for extension of credit, the debtor agrees to (1) The above trade name is adopted by the undersigned who is jointly and severally responsible for all goods and services ordered in this name. (2) I agree to notify you immediately in writing of any changes in ownership or partnership. (3) By ordering service from NonstopDelivery, Inc., you acknowledge that you will be liable for any expenses incurred by NonstopDelivery in collections of delinquent accounts including, but not limited to attorney's fees and collection agency fees. Balances over 30 days old are subject to 1.5% finance charge per month (18% annually) or the maximum allowed by state law. Further, this credit application serves as authorization to release information to NonstopDelivery, Inc.

Authorized by:
Name:
Title:	Date:

Submit