Credit Application Form

We would like to establish a credit account with your organization and therefore we are submitting the following information for your records. *All fields are required.

Billing Address:
*Contact Name:
*Firm Name:
*Address/ City/ State & Zip:
*Telephone:

Shipping Address:
*Contact Name:
*Firm Name:
*Address/ City/ State & Zip:
*Telephone:

Type of Business:

Corporation:

Partnership:

Individual Ownership:

*Check if information is the same as above, otherwise complete information below:

Shipping Information:

Billing Information:

Corporate Officers, Partners & Owners Information:

*Contact Name:

*Address/ City/ State & Zip:

*Telephone:

*Email:

Bank References:
*Bank Name:
*Contact Name:
*Account #:
*Address/ City/ State & Zip:
*Telephone:

Trade References:
*Name (1):
*Address/ City/ State & Zip:
*Telephone:
*Fax:
*Email:
Name(2):
Address/ City/ State & Zip:
Telephone:
Fax:
Email:
Name(3):
Address/ City/ State & Zip:
Telephone:
Fax:
Email:

Requirements To Purchase On Account:

*Name of Whom has the Authority to Purchase:

*Do you require purchase orders?

Yes:

No:

Other requirements:

I/ WE AGREE TO NOTIFY YOU IMMEDIATELY OF ANY CHANGES OF OWNERSHIP. IF GRANTED CREDIT BY YOU, I AGREE TO PAY ALL INVOICES ACCORDING TO YOUR TERMS. THE COMPANY'S FINANCIAL CONDITION IS SATISFACTORY AND I CAN MEET ALL MY PRESENT OBLIGATIONS. I/WE AGREE TO PAY FINANCE CHARGES OF 1.5 PERCENT, PER MONTH ON MY BALANCE 30 DAYS PAST DUE. THIS IS EQUAL TO 18% ANNUM. We understand that invoices not paid within 30 days can result in the suspension of credit privileges. Limitation of Liability - Submission of any film, print, artwork, electronic media, or other materials to Berry and Homer for processing, printing, imaging, or handling constitutes an agreement by you that any damage to the material submitted or loss of the same by Berryn and Homer, our subsidiaries, or agents due to any reason or cause including, but not limited to, our negligence will only entitle you to replacement with a like amount of the unused and new media. The acceptance by Berry and Homer of the film print, artwork, electronic media, or other materials is without other express or implied warranty or liability, and recovery for any incidental or consequential damages is excluded. Berry and Homer assumes no liability for loss or damage to orders in transit to or from Berry and Homer. I make the foregoing application for credit in writing intending that you should rely upon it for purposes of obtaining merchandise and services from Berry and Homer on credit. I hereby authorize Berry and Homer to make inquires of the above referenced bank(s) and trade creditors.

Below is a *required area and all fields must be completed to process this form once submitted.
	*I Agree		(Please type "Yes" in the box.)	I have read and understand the statement above.	*Today's Date: