Credit Application   (print, fill out and fax to Embassy Software)       1) Company/Organization Business Name: Contact Person/Title: Street: Phone: City, State, Zip: Fax: Webpage Address: Email:         Type of business: President or owner: Secretary: Vice President / Partner: Treasurer:     Federal Employment Insurance Number: [  ] Corporation      [  ] Sole Proprietorship     [  ] Partnership     [  ] Goverment Agency     2) Bank Information Bank Name: Contact Person/Title: Street: Phone: City, State, Zip: Fax: Bank Account #: Email:     3) Supplier Reference   (Minimum of three required) Company Name: Phone: City, State, Zip: Fax: Contact Person/Title: Email:   4) Supplier Reference Company Name: Phone: City, State, Zip: Fax: Contact Person/Title: Email:    5) Supplier Reference Company Name: Phone: City, State, Zip: Fax: Contact Person/Title: Email:     6) Terms Note: Terms are Net 30 days, 1.5% per month Finance Charge on unpaid balance after 30 days.  18% annual rate.  If account is sent to a collection agency, a 25% service charge for collection will be added.     Credit Amount Requested:    I agree to terms stated above (signature): Name (printed): Title: Date: