NET 30 APPLICATION

BUSINESS NAME*

BUSINESS PHONE*

BUSINESS FAX

BUSINESS EMAIL*

SHIPPING ADDRESS*

BILLING ADDRESS

POINT OF CONTACT NAME*

POINT OF CONTACT PHONE*

POINT OF CONTACT EMAIL*

ACCOUNTING CONTACT NAME

ACCOUNTING CONTACT PHONE

ACCOUNTING CONTACT EMAIL

PURCHASING CONTACT NAME

PURCHASING CONTACT PHONE

PURCHASING CONTACT EMAIL

PREFERRED METHOD OF PAYMENT*
Invoice (Net 30)Credit Card (3% Fee)

LEGAL ENTITY*

NET 30 TAX ID*

YEAR BUSINESS STARTED*

NAMES AND HOME ADDRESSES OF OFFICERS, PARTNERS, & OWNERS*

TRADE REFERENCE CONTACT NAME*

TRADE REFERENCE CONTACT PHONE*

TRADE REFERENCE CONTACT ADDRESS*

BANK REFERENCE CONTACT NAME*

BANK REFERENCE CONTACT PHONE*

BANK ACCOUNT NUMBER*

*INDICATES A REQUIRED FIELD

403 Westpark Court Suite 210

Peachtree City, GA 30269

OFFICE HOURS:

9:00 AM – 5:00PM, Monday thru Friday

MAILING ADDRESS:

PO Box 428, Senoia, GA 30276

YOUR BARCODING SOLUTIONS – FROM START TO FINISH