Credit Application

ENVELOPES & MORE CREDIT APPLICATION
All fields with (*) must be filled out. All information will be kept in strict confidence. Click here to fill out this form online using our secure server. You can also print out this page, fill it out and fax it to 800-327-7570.

Envelopes & More Terms:

First Order C.O.D or prepaid
Normal Credit Terms Net 15 Days
Tax Exempt Certificate must accompany FIRST ORDER

Name Of Firm Or Individual: *

Account Number: *

Phone: *

xxx-xxx-xxxx

Email Address:

Street Address 1: *

Mail Address if Different:

City: *

State: *

Zip: *

Years At This address: *

OWNERSHIP: *

Corporation

Incorporated Within Last 12 Months

Partnership

Individual

Name (s) of Principal (s):: *

(last name, first name) (at least one principal must be provided) List Each On Separate Line

Gross Sales:: * $

Number Of Employees In Your Company: *

How Long In Business: *

Years and Months

Name Of Your Bank: *

Bank Officer Dept.: *

Bank Address: *

City: *

State: *

Zip: *

Phone: *

xxx-xx-xxxx

Doing Business Since:

dd/mm/yyyy

Average Bank Balance:: * $

Loans?: *

Yes

If Yes, they are:: *

Secured

Unsecured

Satisfactory:: *

Yes

Any Comments?:

Reference #1: Business Name: *

Ref. #1 Business Address: *

Ref. #1 City: *

Ref. #1 State: *

Ref. #1 Zip: *

Ref. #1 Contact: *

Ref. #1 Email:

Ref. #1 Phone: *

xxx-xxx-xxxx

Ref. #1 Fax:

Reference #2:

On separate lines write: Business Name, Address (City, State, Zip), Contact, Email, Phone, Fax

I certify that all the information on this form is correct. I fully understand your credit terms and agree to the proper payment in consideration of extended credit.: *

I Understand

1292 Blue Hills Avenue, Bloomfield, CT 06002-1302
Phone: 1.800.225.7570 Local: 1.860.286.7570 Fax: 1.800.327.7570