Online Credit Application

Company Name
Corporate Name
Address
City	State Zip
Phone
Fax
Email
Retail Sales Tax
Type of Business
How did you hear about us?
Names of Principals or Officer
1. Name		Position
Residence		Phone
2. Name		Position
Residence		Phone
3. Name		Position
Residence		Phone
How long in business?
	years

Bank		Officer
Address
City	State Zip
Trade References (Suppliers)
1. Name		Phone
Address
City	State Zip
2. Name		Phone
Address
City	State Zip
3. Name		Phone
Address
City	State Zip

Comments
Open Account	Limited To	C.O.D. Only
	I hereby affirm that the above information is true and authorize Riverside Paper Supply Co., Inc to investigate and verify the statements. I also agree to pay invoices with the prescribed period of time and acknowledge the fact that any invoices over 30 days old is subject to a monthly finance charge of 2% or the maximum allowed by the law, until such time as the amount due, including both principal and any accumulated interest, is paid in full. I agree to pay a 20% collection fee to cover Seller's expenses in collecting payments due under this agreement.