1. Use your keyboard to fill in the blanks.
    2. On the "Menu Bar", Select "FILE", and choose "PRINT".
    3. When the form is printed erase the form by pressing "RESET at the bottom of the page.
    4. Refer to the Fax or Mailing information boxes below to send your form.
    5. When Finished with this form, make sure your personal information (the filled in blanks are cleared) by using the "RESET" Button.
    6. Click on the link to exit "Secure Server".  This brings up a "Thank You Page", that automatically returns you to Data Label's main webpage.
Your Personal Information Will NOT Be Transmitted .

Mailing Information:

Data Label, Inc.
Attention:  Credit Department
1000 Spruce Street
Terre Haute, Indiana 47807

Be Sure To Enclose A Copy Of Your Resale Certificate.

Fax Information:

FAX Number for Customer Service:
800 367-5103

Keep This Number Handy.  This is also where you Fax Orders!

Be Sure To Fax A Copy Of Your Resale Certificate.

Please Submit A Copy Of Your Resale Certificate When You Send This Application.

Credit Application
Applications For Credit Will Not Be Accepted From End Users.  Data Label Sells For Resale Only.  No Direct Sales.
Company Name:
Name of Owner or Contact:
Billing Address:
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:
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:
City, State:
Phone No.:
Fax No.:
City, State:
Phone No.:
Fax No.:
City, State:
Phone No.:
Fax No.:
If You Need To Make Additional Comments, Make Them Here.
Your Message
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.
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