Credit Application

GENERAL  INFORMATION

Information contained on this form is for the sole purpose of establishing credit terms with Insta Graphic Systems and WILL NOT be shared.  All information will be transferred via SSL (Secure Socket Layer) and encrypted for your protection.

We are interested in:

  Heat Transfers
 Heat Transfer Machines

Company Name:

DBA:

Billing Address:

City:

State:

Zip:

Phone:

Fax:

E-Mail:

Type of Business:

Date Business Started:

Amount of Credit Requested:

Listed w/Dun & Bradstreet:

Status:

Proprietorship Partnership Corporation

State of Incorporation:

SHIPPING ADDRESS (if different from above)

Address:

City:

State:

Zip:

PRINCIPAL OWNERS & OFFICERS

Name:

Title:

Address:

City:

State:

Zip:

Name:

Title:

Address:

City:

State:

Zip:

Name:

Title:

Address:

City:

State:

Zip:

BANK AND BUSINESS INFORMATION

Bank Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Contact Person:

Supplier Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Contact Person:

Supplier Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Contact Name:

Name:

Account Number:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Contact Name:

BILLING TERMS

I wish to be considered for NET 30 DAY terms.

I prefer C.O.D.  shipments.

I prefer to pay by credit card.

Do you Require a Purchase Order?

Yes

No

TAX  INFORMATION

By Law, Insta Graphic Systems must charge sales tax if a valid resale certificate is not completed and returned to us.  A Blanket Resale/Exemption Certificate will be mailed to you within two weeks. To be considered valid the certificate must indicate your resale certificate number and must be signed.  Please indicated the reason for your tax-exempt status:

Resale

Non-Profit

LEGAL  STATEMENT

You agree to pay for all purchases charged to the account. The invoice presented at the point of sale constitutes the official bill of sale. Payment is due 30 days from the date of this invoice. Accounts with unpaid amounts over 30 days from the date  of invoice will be considered delinquent and may be subject to credit hold or withdrawl of terms.  In the event that payment is not made in a timely manner, you agree to pay all reasonable  attorney's fees and court or other collection costs as permitted by law. There will be a $50.00 fee assessed on returned checks to cover administrative costs and bank charges.

   By clicking "Submit Application" you give Insta Graphic Systems the right to use the information provided herein to conduct a credit check and you further agree to be bound by Insta Graphic terms of credit. 

Initial that you have read the above

Please click "Submit Application" button only once.(You will then be forwarded to a confimation page.)