Online Credit Application

General Information

*Legal Name  
*DBA Name  
*Business Type  
*Street Address:  
*Mailing Address:  
*City  
*State  
*Zip  
*Phone:  
*Fax:  
*E-mail:  
DUNS Number:  
*Type of Ownership:

Partnership
Corporation

Subsidiary of:
 
If a corporation, year of incorporation :  
In/under the laws of what state?:  
*Year Business Established::  
*Is sales tax applicable?  
yes no
(If no, the attached resale certificate must be completed.)
*Are purchase orders required?  
yes no

Names of Officers, Partners, Principals

  Person 1  
*Name:  
*Title:  
 *Home Address:  
   
Person 2   
Name:  
Title:  
 Home Address:  
   
  Person 3  
Name:  
Title:  
 Home Address:  
   
 Accounts Payable contact:  
 Accounts Payable title:  

Bank Reference

*Name  
*Phone  
*Address  
*Banking Officer  
*Authorized Release Signature:  

Printing Reference

Name  
Phone  
Address  
Fax:  

Other Trade References

Name:  
Phone:  
Address:  
Fax:  
   
Name:  
Phone:  
Address:  
Fax:  
   
Name:  
Phone:  
Address:  
Fax:  
   

 

Terms & Conditions

An order on open account from a new customer cannot be completed until the credit application has been received and processed. Our terms of sale are Net 30 Days from date of invoice unless otherwise specified. However, payment of postage is required in advance of any mailing drop date. In the event of default, the customer agrees to pay Omaha Print the amount due, including a finance charge of 1 1/2% per month (18% per annum) plus attorney and/or collection fees.

I fully understand and agree to abide by the Credit Policy and terms as stated above and that the information provided is correct to the best of my knowledge.

*I AGREE TO THE TERMS & CONDITIONS ABOVE