Credit Application

Company Name:

Parent Company (if applicable)

Address:

Phone:

Fax:

Email:

Accounting Manager:

Phone:

Fax:

Email:

Billing Address (if different):

Are P.O.’s required?:
YESNO

Send Invoices Via:
E-MailHard CopyFax

Bank Name:

Account Number:

Address:

Phone:

Type of Account:

Company Name:

Address::

Phone:

Fax:

Email:

Company Name:

Address:

Phone:

Fax:

Email:

Company Name:

Address:

Phone:

Fax:

Email:

All invoices are Net 15 (unless otherwise established). All overdue invoices shall accrue a 1.5% monthly finance charge until paid in full. Applicant by signing attests to financial responsibility and acknowledges reading and agreeing to all terms on this application. Signature below authorizes release of bank and trade information to The Script Specialists LLC for credit purposes only. This information is held in the strictest confidence. This document must be signed by the owner, corporate officer or other authorized personnel.