Credit Application

This Application may be:

Filled out online. (Recommended)
Printed, hand or type written and mailed to the address above, or
Printed, hand or type written, and Faxed to us at 800 367-5103.
This Color Page Is Difficult To Print As A Readable Document. To Open A Printable Copy of This Form Click Here.

Credit Application

Applications For Credit Will Not Be Accepted From End Users. Data Label Sells For Resale Only. No Direct Sales.

NOTE:
All Fields are required. If some information is not known, type an X in the field.

Company Name:

Name of Owner or Contact:

Billing Address:

City:

State:

Billing Address Zip or Zip+4:

EMAIL Address:

Other Street Address If same as billing address type "Same":

Zip or Zip+4:

Phone Number:

Fax Number:

(Optional) How did you learn about Data Label?:

Number of sales people:

Years in business:

To Establish An Open Credit Account, We Must (By Law), Have A Copy Of Your Resale Certificate On File. Please Submit A Copy By FAX When You Send This Application. Our Fax No. is: 800 367-5103.

List three MANUFACTURERS you currently do business with:
Name:
City, State:
Phone No.:		Fax No.:
Name:
City, State:
Phone No.:		Fax No.:
Name:
City, State:
Phone No.:		Fax No.:

Our company terms are deduct a 1% discount if paid within 10 days, net due 30 days of our invoice date. If you have security concerns about sending this information over the Web, please feel free to print this application on your printer and fax it to our attention at the fax number listed above.