Media Fast LLC: Application for Credit

APPLICATION FOR CREDIT

For security reasons, fill in the form and fax or mail to Media Fast LLC. The form must be completed with the appropriate signatures and identification numbers.

MEDIA FAST LLC
P.O. Box 712
Lehi, UT 84043

Phone: 801-756-8890
Fax: 801-756-0707

Firm Name:		Date:
Address:
Address:
City:		State: Zip:
Country:

Person to contact regarding accounts payable:
Name: Phone:

Type of business (required):

How long in business (required):

Corporation Partnership Proprietorship LLC
Taxable Nontaxable (if nontaxable, click here)

OFFICERS/PRINCIPALS OF FIRM

1. Name:
Address:
Address:
City:		State: Zip:
Phone:		SS# (required):


2. Name:
Address:
Address:
City:		State: Zip:
Phone:		SS# (required):


3. Name:
Address:
Address:
City:		State: Zip:
Phone:		SS# (required):

Business Bank: Phone:
Bank Address: Account #
Type of Account: Savings Checking Loan

CREDIT REFERENCES/TRADE (local references preferred; omit phone, oil, gas company, and personal credit cards)

1. Name of Firm:		Contact Name:
Address:
Address:
City:		State: Zip:
Phone
Fax:


2. Name of Firm:		Contact Name:
Address:
Address:
City:		State: Zip:
Phone:
Fax:


3. Name of Firm:		Contact Name:
Address:
Address:
City:		State: Zip:
Phone:
Fax:

Media Fast REQUIRES a PO on every order.
Amount of credit requested per month:$

CREDIT AGREEMENT
Please read Terms and Conditions. Customer verifies that the above information is true and correct and hereby grants permission for any person to furnish to Media Fast information which may be requested. Customer also agrees to pay for any and all deliveries under and pursuant to its accounts, whether ordered by the customer or by any person representing himself/herself to be an agent, employee or representative of the company. The undersigned agrees to pay all invoices within the following terms of sale: Net 30 days from date of invoice; past due thereafter. Past-due accounts are subject to a late-payment charge of 2% per month (24% annually). Purchaser agrees to pay in accordance with the foregoing terms of sale and further agrees to pay all collection costs and attorney's fees necessary to collect past-due amounts, as permitted by law. The undersigned PERSONALLY GUARANTEES and PERSONALLY ASSUMES full and ultimate responsibility for payment of all invoices generated under the terms and conditions outlined above, even if company dissolves or is bankrupt. The Terms and Conditions are part of this agreement, and by signing this form you are indicating you have read the terms and conditions and agree to them.

I UNDERSTAND AND AGREE TO THE ABOVE TERMS.
You MUST be an officer or principal to sign.

Signature:______________________________________________

Title: _________________________________________________

Name (Print):___________________________________________ Date: ___________________

APPLICATIONS NOT SIGNED AND COMPLETED IN FULL WILL NOT BE CONSIDERED FOR CREDIT.

OFFICE USE ONLY:
Received:__________ Date Opened:__________ Account No.:__________ Credit Limit Granted:__________

Media Fast, LLC
P.O. Box 712 Lehi, UT 84043
801-756-8890 (office) 801-756-0707 (fax)
BHowell@MediaFast.info