Credit Application

DUNS#*
Legal Business Name*
Trade Info*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name
First Last
Email*
Phone*
Fax
Billing Info*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Contact
First Last
Email*
Phone*
Fax
Business Type*
- Coporation
- Sole Proprietor
- Partnership
- Other
Federal Tax ID Number*
Year Established
Avenue Revenue (May Require Financial Statement)
Bank Reference
The undersigned hereby authorizes the following credit reference to disclose all details necessary to enabled NonstopDelivery to establish an open account.
Bank Name
Account Number
Account Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business References
Must have approved credit for at least the minimum amount requested from NSD.
Company #1*
Company Name
Account Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Company #2*
Company Name
Account Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Terms: Due Upon Receipt
In consideration for extension of credit, the debtor agrees to (1) The above trade name is adopted by the undersigned who is jointly and severally responsible for all goods and services ordered in this name. (2) I agree to notify you immediately in writing of any changes in ownership or partnership. (3) By ordering service from NonstopDelivery, Inc., you acknowledge that you will be liable for any expenses incurred by NonstopDelivery in collections of delinquent accounts including, but not limited to attorney's fees and collection agency fees. Balance over 30 days old are subject to 1.5% finance charge per month (18% annually) or the maximum allowed by state law. Further, this credit application serves as authorization to release information to NSD, Inc.
Authorized by:
Name*
Title*

Credit Application

Bank Reference

Business References

Terms: Due Upon Receipt

Authorized by: