Hub City Blueprint and Tech Plus inc. Tennessee wide large format printers scanners

PLEASE FILL OUT COMPLETELY AND SIGN TO ESTABLISH NET 30 DAY TERMS

Desired Credit Limit

COMPANY NAME:

d/b/a:

Bill to Address

Street Address

City/State

Owners(s)/President

Accts. Payable Contact

AP Phone & Fax #

AP E-mail Address

Banking Institution

Acct. Numbers

Contact

Phone & Fax #'s

Years in Business

Dunn & Bradstreet #

Annual Sales

Net Worth

Number of Employees

Federal Tax ID #

*Please attach reseller's certificate*

Company Structure

Sole Proprietorship Corporation State Partnership LLC

T R A D E R E F E R E N C E S

NAME OF COMPANY:

CONTACT:

CITY STATE

PHONE:

NAME OF COMPANY:

CONTACT:

CITY STATE

PHONE:

NAME OF COMPANY:

CONTACT:

CITY STATE

PHONE:

I authorize the release of the above information to Hub City Blueprint for credit purposes only. In order for Hub City Blueprint to grant me credit, I give permission for my credit to be checked as required for that purpose. Credit terms are net thirty (30) days from the date of invoice. Interest will be charged at 1.5% per month on items over thirty (30) days. If my account is referred for collection, I agree to pay all billing and collection costs and a reasonable attorney's fee. All the above is true and terms are accepted.

Print Officer's Name

Officer's Signature

Officer's Title

Date

Sunday, May 20, 2012