Chroma™ a PlastiColor® Company, Maryville, Tennessee

Online Application for Credit
ALL information must be complete! Please allow 10-14 days for processing.

COMPANY INFORMATION:


Company Name:
Street Address:
City, State Zip:


Phone:
Fax:
Our company is a:

If a division of a subsidiary, name of parent company:

PRINCIPAL OWNER OR OFFICER #1
Name:
Title:
Street Address:
City, State Zip:
Phone:

PRINCIPAL OWNER OR OFFICER #2
Name:
Title:
Street Address:
City, State Zip:
Phone:

PERSON IN CHARGE OF ACCOUNTS PAYABLE
Name:
Phone:

BUYER
Name:
Phone:

TRADE INFORMATION:

(Please do not list C.O.D.'s, bank loans, finance companies, credit cards, utilities, or publications. We accept only trade references.)

TRADE REFERENCE #1
Name:
Street Address:
City, State Zip:
Phone:
Fax:
Account #:

TRADE REFERENCE #2
Name:
Street Address:
City, State Zip:
Phone:
Fax:
Account #:

TRADE REFERENCE #3
Name:
Street Address:
City, State Zip:
Phone:
Fax:
Account #:

TRADE REFERENCE #4
Name:
Street Address:
City, State Zip:
Phone:
Fax:
Account #:

BANKING INFORMATION:

We bank at:
Street Address:
City, State Zip:
Contact:
Phone:

This applicant agrees that should this account be placed with a third party collector, the applicant will pay all collection fees. If placed in the hands of an attorney for collection, the applicant will pay a reasonable attorney's fee in addition to the principal and interest which shall be added to and become part of the judgement. Interest will be applied at the rate of 1.5% per month on amounts more than 30 days old. All orders are subject to credit approval and acceptance by Chroma Graphics.

Applicant Signature:
Title: