Credit Application for Postal Supplies

Application For Credit - Postal Products Unlimited
(a div. of ICM Corporation)

Directions: Please fill out all lines completely.
Print out the Form once you have completed the application.
SIGN the form in the Authorization Area below.
FAX the form back to us at the number below.

1. Information Needed to Set Up Your Account

Please fill out all lines completely

Date //

Anticipated Purchase and/or Amount of Item
$.

Your E-Mail Address
@

Is Your Organization Sales Tax Exempt?

Yes No

If Yes, Please fax your Sales Tax Exempt Certificate to us with this form.

Application Submitted By:
Name

Title

Is Purchase Order Required?

Yes No

P.O.#

Business Fax Number
()-

Business Phone Number
()-

Person to Contact Re: Account

Full Legal Name/Business Entity Doing Business As: Street Address City
State/Country (abbrev. ok) Zip Code + 4 - Number of Employees 1-4 5-9 10-19 20-49 50-99 100+	Annual Sales $	Dun & Bradstreet# Number of Business Locations Since

Billing Street Address (if different than above)

City

State/Country (abbrev. ok)

Zip Code + 4
-

If Subsidiary, Name of Parent Company, Address, City, State, Zip

Business Type (please check one)	82Education/Schools	20Manufacturing/Printing
80Medical/Health	91Government	40Transportation/ Communications/Utilities
87Engineering/ Architecture/Consulting	50Wholesale Trade	15Construction/ Contractors
63Insurance	65Real Estate	52Retail Stores/Restaurants
99Other

2. References for Your Business

Bank Reference #1: Bank Name and Address Line

City & State

Zip Code + 4 - Phone Number ()-
Contact Person

Checking Account #

Bank Reference #2: Bank Name and Address

City & State

Zip Code + 4 - Phone Number ()-
Contact Person

Checking Account #

Trade Reference #1 Name

Account #

Phone Number
()-

Fax Number
()-

Trade Reference #2 Name

Account #

Phone Number
()-

Fax Number
()-

Trade Reference #3 Name

Account #

Phone Number
()-

Fax Number
()-

3. Authorization Is Required

a. Check here if Incorporated for more than one year and type the Principle's Name Below. If you have not been incorporated for more than one year, please refer to section 3b. below.
Company Principle's Name & Title

b. Check here if Incorporated for less than one year, a sole proprietorship, or a partnership and enter Principle's Name Below.
Company Principle's Name & Title

Personal Credit Information / Guarantee
(Must be completed by a corporation in business less than one year, an unincorporated business, a sole proprietorship, or a partnership)
I agree that if my business has been incorporated for less than one year, is unincorporated, a sole proprietorship, or a partnership, I authorize Mail Center Inc. or its' agent to investigate my personal credit financial records, including banking records. It is understood that my personal credit bureau report may be requested by the company to assist in the investigation of my financial records and I personally guarantee the repayment of the debt. If my business has been incorporated for one year or more, it is understood that my personal financial records will not be investigated without my prior authorization.

Company Principle's First Name	Initial	Last Name	Social Security No. --
Present Home Address (Number & Street)			Home Phone Number ()-

City

State

Zip Code

Postal Products Unlimitedis herewith submitted for the purpose of opening an account. By submitting this form, I hereby certify all information to be true and accurate. All information provided will be used by Postal Products Unlimited employees to determine credit worthiness and/or effect collections. Applicant agrees to pay any collection fees incurred to collect the balances owed including reasonable attorney's fees. Postal Products Unlimited reserves the right to assess an interest charge of 1.5% per month (18% annually) on all invoices over 30 days old.

Signature Authorizing Credit Verification and Processing for Credit Approval

Sign the authorization line below and fax back this completed form for Credit Approval. Time is of the essence in returning the faxed signature form and Credit will not be issued without receipt of authorized signature.

Principle or Authorized Signature (Company owner/principle will be held liable for all purchases regardless of party signing credit application, and balances owed are non-transferrable and non-assignable to other parties for any reason.)

Signed________________________________________________________________________Date________________________

Fax Signed and Completed Form to us Toll Free: 1-800-570-0007

Order Toll Free
1-800-229-4500

www.mailproducts.com

In Wisconsin Call:
414-290-1500