New Account Form

    New Account Form

    Legal/Trade Name :
    Billing Address
    Billing Address
    Shipping Address (if different than Billing)
    Shipping Address
    (if different than Billing)

    Accounting and Payment Information

    A/P Contact
    Market Segment: (please choose)

    Phone #
    Fax :
    Requested Terms: (please choose)

    Trade References may be requested
    Federal ID
    Tax Exempt #
    AGREEMENT FOR CREDIT SALES: The above information is for the purpose of obtaining credit and is warranted to be true. I hereby agree to pay all invoices within 30 days of receipt of invoice or as expressly agreed. Interest of 2% may be charged on overdue invoices. I hereby authorize CCI Learning Solutions Inc. to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account.I agree to agreement written above
    Authorized Applicant: Title: Date: