The Business Word Inc. -- Credit Application

Print form and fax to 303-290-9025
Application for Credit

11211 East Arapahoe Road, Suite 101 Centennial, CO 80112-3851 tel 303 290 8500 fax 303 290 9025 www.businessword.com

________________________________________ Company Name	_____________________________ Phone Number
______________________________________________________________________________ Address
________________________________________ City	____________ State	_____________ Zip
________________________________________ Type of Business	____________ Years in Business	_____________ At Present Location
Type of Ownership: Corporation Partnership Individual

If Partnership, Name Partners—If Corporation, Name Officers

Name	Home Address	Title

Tax Exempt? No Yes If so, Tax ID# Please enclose a copy of your tax certificate

________________________________________ Name of Bank	_____________________________ Account Number
______________________________________________________________________________ Address
________________________________________ City	____________ State	_____________ Zip
________________________________________ Phone Number

Credit References
Please list companies who normally respond to credit inquiries.
Do not list credit card accounts, phone company, insurance company or public service company.

Vendor Name	Street Address, City & State	Phone #	Acct #

Agreement
Applicant agrees that extension of credit by seller shall be subject to and in consideration of the following:
1. Payment terms are net 30 days from invoice date.
2. Past-due balances are subject to a service charge of 1.5% per month. This is an annual percentage rate of 18%.
3. Should it be necessary to assign the account balance to a licensed collection agency or attorney for legal action, all subsequent collection costs and reasonable attorney's fees shall be paid by the applicant and any all guarantor(s).
4. All disputed invoices must be claimed in writing within 10 days of invoice date.
5. The undersigned hereby authorizes the above mentioned banks and companies to release information requested, and authorizes The Business Word, Inc. to obtain any investigative reports on applicant.
6. The undersigned agrees to the terms and conditions stated herein and attests to the financial responsibility, ability and willingness of the Applicant to pay our invoices in accordance with our terms.

Signed:________________________________ Title:___________________ Date:________
Must be officer, owner, or partner.