Credit Application

GENERAL INFORMATION
Registered Name:
DBA or Trade Name:
Phone:
Fax:
Physical Address
City:
State, Zip		State Zip:
Payment Contact:		Phone: ext.

Are Purchase Orders Required?		YES NO
Is application in connection with an agency relationship?		YES NO
Credit line desired $$:

BUSINESS INFORMATION AND HISTORY
Corporation or Partnership?
If incorporated, state of incorporation:
Type of business:
If other, Please describe:
Year established:
Under present ownership since:
Number of locations:		Owns: Rents:
Number of employees:
Sales tax status:		Taxable Exempt* Resale**
	*If Exempt, a copy of the exemption certificate required. **If Resale, a copy of the Resale Sales Tax License required.
Federal ID Number:
Dun & Bradstreet Number :

Please provide the name and title of each officer:
	Name	Title	Officer's SSN (if sole proprietor or partnership)
1
2
3
4
5

TRADE AND BANK REFERENCES
Please list 3 trade references including one print related supplier
TRADE REFERENCE NO. 1
Name:
City:		St. Zip:
Highest Recent Credit:
Account Number :
Contact Person:
Phone Number:
Fax Number:

TRADE REFERENCE NO. 2
Name:
City:		St Zip:
Highest Recent Credit:
Account Number (if available):
Contact Person:
Phone Number:
Fax Number:

TRADE REFERENCE NO. 3
Name:
City:		St Zip:
Highest Recent Credit:
Account Number (if available):
Contact Person:
Phone Number:
Fax Number:

BANK REFERENCE
Bank Name:
City:		St Zip:
Bank Account Number:
Account Type:
Contact Person:
Phone Number:
Fax Number:

AUTHORIZATION
Signature	Title	Date
By typing my name above, I agree that the information provided above has been provided for the purpose of obtaining credit and I authorize Al Chait Enterprises, Inc., dba Greenway Print Solutions ("Greenway"), to verify all of the above including, but not limited to, checking credit reports, trade references and bank references. I understand the credit terms (unless otherwise agreed to in writing by Greenway) are net 30 days, with a credit card backup to be charged at day 31 if invoice is not paid, from the invoice date and agree to remit payment for credit extended accordingly. In the event the account is not paid according to the terms of this credit application, I understand my account is subject to a 1.5% (18% per annum) monthly late fee and agree to remit, along with the balance due, all fees associated with collecting any past due balances, including, but not limited to, collection agencies, attorneys, court costs, filing fees, etc.
PERSONAL GUARANTEE
Name	Social Security Number	Date
Signature _____________________________________________________________________
By signing my name above, I am agreeing that in consideration of the requested credit line with Greenway, I unconditionally guarantee the payment of all sums due Greenway on such account. This shall include all balances due, late fees, collection fees, Court fees, attorney's fees and all other related fees incurred if the account is not paid in full within the terms stated above. I also agree to allow Greenway to check my personal credit.

Please print this completed report and fax it to 602-482-1127