An email address is needed to process application. State reseller certificates signed or tax certificates are needed to open an account.

Business Name

Parent Company/DBA/Name & Address

Street Address

Mailing Address

City, State, Zip Code

Type Business (Proprietorship, Partnership, Corporate)

Name of President or Owner

Tax ID #

Exempt ID #

Telephone #

Fax #

Duns #

Purchasing Agent

Website Address

Years in Business

Trade References

Name

Type Business

Address

City, State, Zip Code

Telephone #

Email Address *

Name

Type Business

Address

City, State, Zip Code

Telephone #

Email Address

Name

Type Business

Address

City, State, Zip Code

Telephone #

Bank Information

Email Address *

 *

I hereby authorize Reliant Ribbon Corporation to verify the above information

In consideration for the extension of credit, the applicant promises to pay for all purchases within the terms agreed and agrees to pay a service charge per month of 1-1/2% per month (18% annual percentage rate) on all past due balances. In the event any third parties are employed to collect any outstanding monies owed by the applicant, the applicant hereby agrees to pay all reasonable collection costs, including attorney fees, whether or not litigation has commenced, and all costs of litigation incurred. The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified in this credit application.

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