NRI Plan Express CREDIT APPLICATION INSTRUCTIONS 1. Form should be submitted by an authorized representative of your company. 2. Complete all fields to be provided by your company. (Do not complete fields to be provided by your references) 3. Print, sign and fax to OR print, sign, scan and e-mail to VDOHV#SODQH[SUHVVQHW. New York | Princeton | Philadelphia | Washington, DC | Boston | San Francisco | Atlanta | 0HPSKLV | Chicago NRI PLANEXPRESS APPLICATION FOR CREDIT Date:_ _______________________________________________ Submitted By:_ ________________________________________ Legal Name of Firm: ___________________________________ Title ________________________________________________ Billing Address: Service Address is same as Billing Address (if not, please complete) ____________________________________________________ ____________________________________________________ City: __________________ State: ______ Zip: ____________ City: __________________ State: ______ Zip: ____________ Phone:_______________________________________________ Fax:_________________________________________________ Federal I.D. / S.S. #:_ ___________________________________ E-mail Address:________________________________________ Form of Organization: Corporation ¨ Partnership ¨ Primary Line of Business: Architect ¨ Engineer ¨ Sole Proprietor ¨ Designer ¨ Years in Business:______________________________________ LLC ¨ Other ________________________ Other ____________________________ (please indicate) Number of Employees:_ _________________________________ Resale Sales Tax or Exemption Number: _________________________________________ (if applicable) Attach Resale of Exemption Certificate Please provide information on the Principal Partners or Owners. For corporation, provide information on Authorized Officers. Click here if one name is the same as submitter Name: ______________________________________________ Name:_ ______________________________________________ Title: ________________________________________________ Title: ________________________________________________ Address: _________________________________________ Address: City: __________________ State: ______ Zip: ____________ City: __________________ State: ______ Zip: ____________ _________________________________________ Billing Contacts: Click here if this information is the same as your company information (edit to change name or contact info) Contact Name: _____________________________________ Address: _____________________________________________ City: __________________________________State_________ Zip_______________ Fax: ___________________________ Billing Frequency: ______Weekly AP Phone: ___________________________ _______ Bi-weekly Billing email Address: ________________________________________________________________ (The address to which paperless invoices should be sent) How did you come to 3ODQ([SUHVV? (fill in appropriate line)>2SWLRQDO@ Salesperson: _________________________________________ Referred By: _________________________________________ Standard payment terms are Net 30 days Please note our remit address for your records: Plan Express, Inc. Dept. CH 17588 Palatine, IL 60055-7588 Continue to Next page Page 1 of 3 Business References Where Credit is Extended Please provide at least two (2) references (please indicate trade references only; not utilities, credit cards, etc. as they will not verify credit) Business Name: ______________________________________ Business Name: ______________________________________ Address: ____________________________________________ Address: ____________________________________________ City: __________________ State: ______ Zip: ____________ City: __________________ State: ______ Zip: ____________ Phone: ___________________ Account #: _________________ Phone: ___________________ Account #: _________________ Fax: ___________________ Contact: _____________________ Fax: ___________________ Contact: _____________________ E-mail Address: _______________________________________ E-mail Address: _______________________________________ All accounts are due and payable Net 30 days. Credit terms are subject to periodic review and may be modified at the discretion of NRI Plan Express Inc. All costs incurred for collection including reasonable attorney fees will be paid by the applicant. CERTIFICATION AND AUTHORIZATION TO RELEASE INFORMATION I hereby acknowledge that I have read and understand the terms and conditions enumerated on this application and certify that I agree to abide by them. I further certify that the information in this application is correct and is for the use of National Reprographics Inc. in determining the amount and conditions of credit to be extended. I hereby authorize the bank and supplier references listed on this application to release the information necessary to assist NRI Plan Express Inc. in establishing a line of credit. Firm Name: __________________________________________ ____________________________________________________ Authorized Signature Title: ________________________________________________ Date: _______________________________________________ The following sheets are included so that you can provide us with financial references. Please complete your portion of the request form, including the signature of authorized representative for your firm for each bank reference you provide. Without an authorized signature from you we will not be able to complete our inquiry and open credit for your firm. Continue to Next page Page 2 of 3 Bank References-- to be completed by applicant. Please provide at least one banking reference Bank Name: __________________________________________ Bank Contact Name: ___________________________________ Branch Address: ______________________________________ City: __________________ State: ______ Zip: ____________ Phone: __________________ Account #: _______________________________ Fax: _____________________ Account Type: ________________ Firm Name: __________________________________________ Address ___________________________________________ City _______________________ State ________ Zip ________ Request Authorized by Name: _________________________________________ ________________________________________________________ Authorized Signature Title: ________________________________________________ Date:______________________________________________ This portion to be completed by financial institution You have been listed as a reference by the customer listed above for establishing an account with NRI Plan Express. Please indicate below the appropriate information and return by fax at 901.869.2490 or email to [email protected] Account Type_________________________________________ Credit Facility Yes________ No _______ Date Opened: ______________________________ Insufficient funds? Credit Amount _____________________________ Current Balance: ____________________________ Yes ______ No ______ if yes, last NSF (mm/yy): ________________________ Average Balance last twelve months: __________________________________ Reference Given by: _____________________________________ Title ____________________________________ Thank you in advance for your prompt attention to this request. Please be assured that all information provided will be held in strictest confidence. Sincerely, NRI Plan Express Accounting 901.843-2142 SAVE PRINT Page 3 of 3