New Account Application

Commercial Accounts Only. To request Net 30 Day billing terms: Please print this form. Complete all blanks (please write neatly, if not typing) and fax it to 318-227-8893.

About Your Company
Legal Business Name
Your Name
Title
Street Address
State		Phone
Zip		Fax
Email Address
Business Established (Month & Year)
Federal Tax ID #		D&B#
(Circle One)	Corporation   Sole Proprietor   Partnership Government Agency   Public School   Private School

Your Accounts Payable Department
Accounts Payable Contact Name
Phone
Fax
Email Address

Credit References
Please fill in ALL information, 3 references are required. If you need more space, please use the back.
Creditor	Account Number	Phone
Bank Information
Your Bank Name
Bank Account Number
Bank Contact Name
Your Bank Phone
Your Bank Fax

If approved for account, your PO MUST reflect these terms on the FACE of the order. By submitting this form, you authorize us to check the credit references provided. We may require a payment security, in the form of a valid credit card number, or a deposit for your first order. We reserve the right to refuse to open a business account at our discretion.

Officer-Owner Signature_____________________________________

Printed Name___________________________  Date______________