RequestAccount - Arctic Office Products

To establish your account please fill out the form below and a member of our team will contact you as soon as possible. If you would like to have us charge to a credit card simply leave the credit reference fields blank and we will be in touch to get your credit card information. Do not input credit card or secure information here.

*Name of Firm or Individual

*Billing Address

*Zip Code

*Email Address

*Delivery Address

*Zip Code

*Phone Number

()

Fax No

()

*Years in Business

Business Type

*Corporation

yes or no

*Individual

yes or no

*A/P contact & #

Principle owners below.

*Owner Name / Title

*Owner Name/Title

*Will you be using a credit card?
Will you be using a credit card?

	YES
	NO

Requested Line of Credit (IF NOT USING CARD)

Trade Credit Reference1 (please include full name, phone, fax, & full address)

Required unless you will be using a credit card.

Trade Credit Reference2 (please include full name, phone, fax, & full address)

Required unless you will be using a credit card.

Trade Credit Reference3 (please include full name, phone, fax, & full address)

Required Unless you will be using a credit card.

*Contact Person
This is not a secure web page: Please provide us with the name and phone number for the person who will be providing any secure information.

Purchase Orders?
Does your company require purchase order numbers on invoices?

	N/A
	Yes

Authorized Buyers?
If you would like us to limit who can charge to this account please list your authorized buyers here.

Notice: The undersigned affirms that the information on this application is true and correct and authorizes Arctic Office Products to obtain a credit report on the undersigned or obtain information from any source required to process this application.

The undersigned agrees to pay each invoice within fifteen (15) days, pay 1.5% service charge per month on all invoices 61 days or older, and to pay all fees in the event that collection efforts become necessary.

Signature of Officer/Owner

*Title

*Date

Where did you hear about us?
Sales Representative's Name, Advertising, Web Search, etc.

*Required Fields