Credit Application

Company Info:

Company Name:

Address:

City:

State:

Zip:

Office Phone:

Fax Phone:

Business Type:     � Individual     � Proprietorship    � Corporation    � Partnership:

Contact:

Email:

Web Site:

Years in Business:

Fed Tax ID or SS Number:

If social security number
used, please provide name of
the owner of that number

Business Type:

Billing Info:

Company Name:

Address:

City:

State:

Zip:

Office Phone:

Fax Phone:

Contact:

Email:

Trade References:

Company Name:

Phone:

Contact:

Years Doing Business

1:

2:

Banking Info:

Bank Name:

Years Doing Business

City:

State:

Zip:

Office Phone:

Fax Phone:

Contact:

Email:

Acceptance:

I hereby authorize Innovative Communications (ICS) to conduct a routine credit check in connection with my application for services.  ICS may use any information obtained through this credit application or any reporting agencies.  I understand this information will be held in strict confidence and will remain ICS property whether or credit is extended.

Owner/President

Authorized Signature:

Title:

Print Name

Date: