1.  Credit Application  [Items marked with * are required fields]

Date: / /
Name:*
Title:*
Social Security #:*
Driver License #:*

State:*
Mailing Address:*
City:* State:*   Zip:*
Phone #:*
Fax #:
Email:*

2.  Corporate Information 

[for corporation only; skip to no. 4  if you are an individual buyer]

Legal Business Name:
Federal ID No.:
Type of Business: Corporation        Partnership          Sole Prop
Year Business Started:
Contact Name:
Parent Company (if applicable):
Have you ever filed bankruptcy?       Yes            No
If yes, when? / /
Business or Personal?

3.  Trade References

[for corporation only; skip to no. 4  if you are an individual buyer]

Name:
Address:
Address2:
Phone:
Name:
Address:
Address2:
Phone:
Name:
Address:
Address2:
Phone:

4.  Bank Reference [Items marked with * are required fields]
Bank Name:*
Address:
Address2:
Phone:*
Checking Acct #:*
Saving Acct#:*
Loan Acct#:*

5. Authorization [ Please Read ]

The undersigned certifies that the information and statements made in this application are true and correct and are made for the purpose of including Package Design Global to establish an open line of credit.  The undersigned acknowledges that unless otherwise stated, terms are "1% 10, Net 30" and agrees to pay reasonable attorney or collection fees plus interest in the event of default of payment within the prescribed terms.  All accounts are subject to a service charge of 1 1/2% per month, 18% annual rate.  

"I hereby authorize all references including banks to release any and all information pertaining to my account."

 

Please review your form and make sure everything is correct and complete before you submit the form. Any application that is not properly completed may be rejected.