Billing Address
Legal/Trade Name :
Street Number and Name :
City :
State/Province :
Zip/Postal Code :
Contact Name :
Phone # :
Fax # :
Email :
Shipping Address (if different than Billing)
Accounting and Payment Information
Phone Number :
Note: Trade References may be required.
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:
