Please fill out all appropriate
fields in your case. If your not applying for credit disregard the
reference section.
Contact
Name:
First:
Last:
Company
Name:
Please check
one):
Corporation
|
Partnership
|
Proprietorship
Billing
Address:
Phone
# at:
Work:
Other#
Fax #:
E-Mail
Address:
Account
Type:
Credit Margin Required
Account
Usage
FTP
|
Plan Room Hosting
|
Ordering (You may select more than one)
Did
you receive a Quote#:
If paying with Credit Card please fill out
Credit
Card Type:
Name
on Card:
Credit
Card #:
include
spaces
#'s
on Back of Card:
in signature box
Expiration
Date:
Company
Information
Proprietors/Officers:
Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:
Accounts
Payable Officer:
Length
of Time in Business:
When (Year) Established:
Nature
of Business:
References
Trade
References:
1.
Name:
Address:
Phone:
| Fax:
| How Long Dealing:
2.
Name:
Address:
Phone:
| Fax:
| How Long Dealing:
Bank
Reference:
Bank:
| Bank Branch:
Tax
Numbers:
GST
PST
Special
Instructions:
By
submitting this form, I/We make application for open terms and certify
that the information given for the purpose of opening this account is
true. I/We authorize verification of the above facts. I/We accept the
Vendor's privilege to charge interest on all overdue accounts.
We will contact you with your new account # as soon as your
application has been processed. For all credit applications the use of
this form is to start processing your request. We will still require an
original signature. Please download our credit application form here and
fax or mail it in. Final credit acceptance will not be made until we
receive this form. Down load Here Thank You for using Illinois Blue
Illinois
Blueprint Corporation
800 S. W. Jefferson Avenue
Peoria, IL. 61605-3943
PH. (309) 676-1300
FAX. (309)-676-1310
