Credit Application

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Shipping Address

Address
City
State
Zip

Billing Address

Are the billing and shipping addresses the same?

Address
City
State
Zip

Accounts Payable

Accounts Payable Name

Type of Organization
Corporation
Partnership
Individual

If Corporation, Date and State of Incorporation

Date
State
Years in Business
Type of Business
Owners and/or Officers

OPGA Member?
Yes
No

References

Bank
Address
Bank Officer Name
Bank Officer Phone

Reference 1

Name of Creditor
Address
Phone
Fax

Reference 2

Name of Creditor
Address
Phone
Fax

Reference 3

Name of Creditor
Address
Phone
Fax

Submitting this form means agreement to our terms net 30 days. A time price differential of 1.5% per month (18% per annum) will be charged on all past due accounts.

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Credit Application

Company Information

Shipping Address

Billing Address

Accounts Payable

If Corporation, Date and State of Incorporation

References

Reference 1

Reference 2

Reference 3

What Being Number One is All About

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