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* SolePartnershipCorporation 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 VISIT US 403 Westpark Court Suite 210 Peachtree City, GA 30269 OFFICE HOURS: 9:00 AM – 5:00PM, Monday thru Friday CONTACT US 1-855-214-9554 CUSTOMERSUPPORT@INDUSTRIALIMAGINGPRODUCTS.COM MAILING ADDRESS: PO Box 428, Senoia, GA 30276