CREDIT APPLICATION

NRI Plan Express
CREDIT APPLICATION
INSTRUCTIONS
1. Form should be submitted by an authorized representative of your company.
2. Complete all fields to be provided by your company.
(Do not complete fields to be provided by your references)
3. Print, sign and fax to OR print, sign, scan and e-mail to VDOHV#SODQH[SUHVVQHW.
New York | Princeton | Philadelphia | Washington, DC | Boston | San Francisco | Atlanta | 0HPSKLV | Chicago
NRI PLANEXPRESS
APPLICATION FOR CREDIT
Date:_ _______________________________________________
Submitted By:_ ________________________________________
Legal Name of Firm: ___________________________________
Title ________________________________________________
Billing Address:
Service Address is same as Billing Address (if not, please complete)
____________________________________________________
____________________________________________________
City: __________________ State: ______ Zip: ____________
City: __________________ State: ______ Zip: ____________
Phone:_______________________________________________
Fax:_________________________________________________
Federal I.D. / S.S. #:_ ___________________________________
E-mail Address:________________________________________
Form of Organization: Corporation ¨
Partnership ¨
Primary Line of Business: Architect ¨
Engineer ¨
Sole Proprietor ¨
Designer ¨
Years in Business:______________________________________
LLC ¨
Other
________________________
Other ____________________________ (please indicate)
Number of Employees:_ _________________________________
Resale Sales Tax or Exemption Number: _________________________________________ (if applicable)
Attach Resale of Exemption Certificate
Please provide information on the Principal Partners or Owners. For corporation, provide information on Authorized Officers.
Click here if one name is the same as submitter
Name: ______________________________________________
Name:_ ______________________________________________
Title: ________________________________________________
Title: ________________________________________________
Address: _________________________________________
Address:
City: __________________ State: ______ Zip: ____________
City: __________________ State: ______ Zip: ____________
_________________________________________
Billing Contacts: Click here if this information is the same as your company information (edit to change name or contact info)
Contact Name:
_____________________________________
Address: _____________________________________________
City: __________________________________State_________ Zip_______________
Fax: ___________________________ Billing Frequency: ______Weekly
AP Phone: ___________________________
_______ Bi-weekly
Billing email Address: ________________________________________________________________
(The address to which paperless invoices should be sent)
How did you come to 3ODQ([SUHVV?
(fill in appropriate line)>[email protected]
Salesperson: _________________________________________
Referred By: _________________________________________
Standard payment terms are Net 30 days
Please note our remit address for your records:
Plan Express, Inc.
Dept. CH 17588
Palatine, IL 60055-7588
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Business References Where Credit is Extended
Please provide at least two (2) references
(please indicate trade references only; not utilities, credit cards, etc. as they will not verify credit)
Business Name: ______________________________________
Business Name: ______________________________________
Address: ____________________________________________
Address: ____________________________________________
City: __________________ State: ______ Zip: ____________
City: __________________ State: ______ Zip: ____________
Phone: ___________________ Account #: _________________
Phone: ___________________ Account #: _________________
Fax: ___________________ Contact: _____________________
Fax: ___________________ Contact: _____________________
E-mail Address: _______________________________________
E-mail Address: _______________________________________
All accounts are due and payable Net 30 days. Credit terms are subject to periodic review and may be modified at the discretion
of NRI Plan Express Inc. All costs incurred for collection including reasonable attorney fees will be paid by the applicant.
CERTIFICATION AND AUTHORIZATION TO RELEASE INFORMATION
I hereby acknowledge that I have read and understand the terms and conditions enumerated on this application and certify that I agree to
abide by them. I further certify that the information in this application is correct and is for the use of National Reprographics Inc. in determining the amount and conditions of credit to be extended. I hereby authorize the bank and supplier references listed on this application
to release the information necessary to assist NRI Plan Express Inc. in establishing a line of credit.
Firm Name: __________________________________________
____________________________________________________
Authorized Signature
Title: ________________________________________________
Date: _______________________________________________
The following sheets are included so that you can provide us with financial references. Please complete your portion of the
request form, including the signature of authorized representative for your firm for each bank reference you provide. Without
an authorized signature from you we will not be able to complete our inquiry and open credit for your firm.
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Bank References-- to be completed by applicant. Please provide at least one banking reference
Bank Name: __________________________________________
Bank Contact Name: ___________________________________
Branch Address: ______________________________________
City: __________________ State: ______ Zip: ____________
Phone: __________________ Account #: _______________________________
Fax: _____________________ Account Type: ________________
Firm Name: __________________________________________
Address ___________________________________________
City _______________________ State ________ Zip ________
Request Authorized by
Name: _________________________________________
________________________________________________________
Authorized Signature
Title: ________________________________________________
Date:______________________________________________
This portion to be completed by financial institution
You have been listed as a reference by the customer listed above for establishing an account with NRI Plan Express.
Please indicate below the appropriate information and return by fax at 901.869.2490 or email to [email protected]
Account Type_________________________________________
Credit Facility
Yes________ No _______
Date Opened: ______________________________
Insufficient funds?
Credit Amount _____________________________
Current Balance: ____________________________
Yes ______ No ______ if yes, last NSF (mm/yy): ________________________
Average Balance last twelve months: __________________________________
Reference Given by: _____________________________________ Title ____________________________________
Thank you in advance for your prompt attention to this request. Please be assured that all information provided will be held
in strictest confidence.
Sincerely,
NRI Plan Express Accounting
901.843-2142
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