Credit Application

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Firm Name:		Date of Application:

Address:	Street:
	City:	State: Zip:
Billing Address :	Street:
	City:	State: Zip:

Telephone Number:		Fax Number:
Principal Business:		CA Resale #:
In Business Since:		Date Incorporated:
Federal Tax ID #:		Type of Firm:

Sales Volume last fiscal year:

Estimated amount of credit desired:

Estimated Sales Volume current fiscal year:	$

BANK REFERENCE:

Full name of bank:
Full address of home:
Phone number of branch:		Branch contact:

Account Number(s):

Commercial

Checking

Savings

CREDIT REFERENCES:

Company Name :
Address:

Telephone Number:		Contact Person:
Highest credit granted: $		On open account?

Company Name :
Address:

Telephone Number:		Contact Person:
Highest credit granted: $		On open account?

State any information that you consider pertinent to an evaluation of your credit:

Name of Parent Company, if subsidiary:

Facts on Proprietor, Partners or Office:

Name:		Name:
Title/ Position:		Title/ Position:
Social Security #:		Social Security #:
Street Address:		Street Address:
City, State, Zip:		City, State, Zip:

By signing below, the undersigned applicant acknowledges and agrees that, except as otherwise expressly agreed in writing, the Terms and Conditions of Sale set forth on the reverse side of this Credit Application shall apply to all transactions between Imperial Media Services and the Applicant.

Initial Here: Executed on behalf of Applicant


Name:
Title:
Date:

Imperial Media is the Nations leading short run duplication service offering DVD manufacturing proudly supplying disc duplication and DVD replication services
to CD duplicators, indie artists, videographers, post production houses, and corporate clients in: Los Angeles California

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The fastest short-run CD duplication, DVD duplication & Blu-Ray duplication in Los Angeles.