Name: .......... Date:

Address: e-mail

Phone Numbers: Business Accts.Payable Cell . ..........

Business Operates as: Corporation Partnership Solo Proprietor..............

Type of Business Date Estab

Federal ID Number Contact for Accounts Payable

Trade References

Name Contact

Address,City & State Telephone

Name Contact

Address,City & State Telephone

Bank Reference

Name Contact Officer

Address,City & State Telephone

I (we) agree that payments will be made in accordence with terms Net 15 days (EOM) A service charge of 1.5% per month will be charged on all past due balances when account is over 30 days past due, and that if my (our) account is referred to an attorney for collections, I (we) will be responsible for reasonable attorney's fees and court costs.

Signature Title

By submitting this form you agree to the terms above

Thank you for choosing Sykes Printing