Ricoh G700SE User Manual download pdf (Page 5)

J-9472/DG 5 7/7/11

IN-HOUSE USE

ORIGINATED BY _____________ DEPT. ______________ PHONE ______________ CLIENT'S REQUEST $

ESRI

CREDIT APPLICATION

COMPANY INFORMATION

COMPANY NAME: TELEPHONE:

DBA: FAX:

ADDRESS: CONTACT:

TAX EXEMPT: YES/NO. IF YES, PLEASE ATTACH

COPY OF EXEMPTION CERTIFICATES FOR ALL STATES.

LENGTH OF TIME IN BUSINESS: FEDERAL ID NO.:

NUMBER OF EMPLOYEES:

CORPORATION PROPRIETORSHIP PARTNERSHIP

IF A CORPORATION, IN WHAT STATE INCORPORATED:

DATE OF INCORPORATION:

PRESIDENT: VICE PRESIDENT:

PARTNER'S NAME(S):

PERSONS WITH CORPORATE SIGNATORY AUTHORITY:

COMPANY CLASSIFICATION: FORTUNE 500 UNIVERSITY, COLLEGE, OR PUBLIC SCHOOLS

LOCAL, STATE, OR FEDERAL GOVERNMENT NONE OF THE ABOVE

BRIEFLY DESCRIBE YOUR COMPANY'S FUNCTION:

BANK REFERENCE

(Please list all banks and banking account numbers; attach additional pages if necessary.)

BANK NAME: TELEPHONE:

ADDRESS: CONTACT:

CHECKING ACCOUNT NO.:

OTHER ACCOUNT NO.:

LOAN NO.:

VENDOR REFERENCE

(PROVIDE 5)

NAME: NAME:

ADDRESS: ADDRESS:

TELEPHONE: TELEPHONE:

NAME: NAME:

ADDRESS: ADDRESS:

TELEPHONE: TELEPHONE:

NAME:

ADDRESS:

TELEPHONE:

ENVIRONMENTAL SYSTEMS RESEARCH INSTITUTE, INC. (ESRI), PAYMENT POLICY:

NET 30 DAYS, 1.5 PERCENT LATE FEE PER MONTH AFTER 30 DAYS.

BY SIGNING BELOW, COMPANY CERTIFIES AND ATTESTS FINANCIAL RESPONSIBILITY FOR ANY AND ALL CORRECT ESRI INVOICES

TO COMPANY AND ITS ABILITY TO PAY SUCH INVOICES IN ACCORDANCE WITH ESRI'S PAYMENT POLICY. COMPANY FURTHER

AGREES TO PAY REASONABLE ATTORNEY'S FEES, PLUS INTEREST, IN THE EVENT OF DEFAULT IN PAYMENTS IN COMPLIANCE WITH

ESRI POLICY. THE INFORMATION CONTAINED HEREIN IS ONLY FOR THE PURPOSE OF OBTAINING CREDIT AND AUTHORIZES ESRI

TO OBTAIN INFORMATION CONCERNING COMPANY'S CREDIT STANDING.

PLEASE FAX TO ESRI CREDIT ANALYST AT 909-307-3031 AND MAIL ORIGINAL.

BY: DATE:

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Ricoh G700SE User Manual Page 5

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