Credit Application

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Application for Credit

Name (Exact legal name for billing purposes)

Shipping Address

Phone Number

Fax Number

Email and Web Site address

Billing Address (if different)

Nature of Business

Date Business Started

State of Incorporation

Sales Tax Exemption Number

Estimated Annual Value of orders from GNU Press

Contact for Invoice Inquiries

TWO SUPPLIER REFERENCES ARE REQUIRED: (U.S. References Preferred)

Name _____________________________________________
Address _____________________________________________
Telephone _____________________________________________
Fax _____________________________________________

NOTE: In addition to the above, please enclose a copy of your most recent financial statements.

Name & Address of Bank
_____________________________________________
_____________________________________________
Account Number _____________________________________________
Contact _____________________________________________
Phone Number _____________________________________________

If credit is granted, I/we understand the terms of sales are net 30. I/we do hereby jointly, and individually agree to pay for all goods and merchandise supplied to me; or to any of us, to the above business. In the event that an account is placed with a third party for collection, I/we agree to pay all costs; including reasonable attorney fees, court costs, and finance charges. I/we authorize GNU PRESS to investigate our credit history, bank references, and other information deemed necessary to extend credit.

Authorized Signature:_____________________________________________

Title and Date: _____________________________________________

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Updated: $Date: 2006/05/01 10:04:13 $ $Author: ramprasadb $