novamedia
1724 North State Street, Big Rapids, MI 49307-9073 * Voice & Fax: [231]796-4637


CREDIT APPLICATION
 

Ownership:  

Company Name:     _______________________________________________________________________

DBA/Parent/Subsidiary      _________________________________________________________________

Address    ______________________________________________________________________________

City     _________________________________________________________________________________

State   ___________

Zip       _____________

Phone   ________________________

Established in (MO/YR)        ____________               

Federal Tax I.D. #               ____________________

Past 12 Months’ Gross Sales      _______________

Number of Employees   _______

Percentage of Gross Sales        ________________

Number of Stocking Locations   ________________

Do you floor plan, If yes name company (s)      _______________________________________________

Do you use purchase orders      ________________

Authorized Buyers:

Name and Title:                _________________________________________

Name and Title:               _________________________________________

NOTE: Please include the appropriate Sales Tax Exemption Form from your State.

Attach Financial Statement (audited preferred)

 

Bank References:

Bank Name                        _________________________________________

Address                      ____________________________________________

Phone Number                __________________________

Checking Account    _____________________________________________

Savings Account Number      ______________________________________

Account/Loan Officer      _________________________________________

Phone number of above     ________________________________________

Trade References: (Related industry and floor plan preferred)

Name, mailing address, telephone number, account number

(1)                   ___________________     

(2)               ___________________         

(3)                ___________________        

(4)                ___________________        

 

By signing this agreement, I/We authorize the release of credit and bank information to Nova Review, Inc. by the references listed above.

 

                _______________________________             

Signature   and   Date

                      _______________________________       

Print Name and   Title   

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