Credit Application

Please fill out the following form and we will contact you as soon as we are available.
Name:
Company:
Phone Number:
Fax:
Email:
Address (Street, City, State, Zip):
Accounts Payable Name:
Accounts Payable Phone:
Type of Business:		Select One Corporation Partnership Individual Owner
Bank Reference
Bank Name:
Address (Street, City, State, Zip) :
Phone:
Fax:
Account #:
Trade References (Firms with whom currently doing business)
1.	Name:
Phone:
Fax:
Address (Street, City, State, Zip):
Highest Credit:
When:
2.	Name:
Phone:
Fax:
Address (Street, City, State, Zip):
Highest Credit:
When:
3.	Name:
Phone:
Fax:
Address (Street, City, State, Zip):
Highest Credit:
When:
Years in Business:
Expected Annual Sales:
Electronic Signature
By submitting this form I give approval for North Coast Tape & Label, Inc. to request information about our firm. If credit is not approved, I will be notified.
Your Name:
Title:
Anti-Spam Image Verification:		Please enter the text from the image   REFRESH (If you can't read the image and would like a new one). What is this?