Credit Application

A pre-qualification for terms with Adams Publishing Group.

Legal Name(Required)

Trading Name / DBA(Required)

Address(Required)

Street Address City State ZIP / Postal Code

Phone(Required)

Email(Required)

If Division / Subsidiary

Name of Parent Company

Address

Street Address City State / Province / Region ZIP / Postal Code

Any Previously Registered Business Names / DBA

(Within the Last Three Years)

Business Name

Business Details

Years Established(Required)

Enter the number of years the company has been established.

State of Incorporation(Required)

Please select the state where your business is incorporated.

State of Business(Required)

Please select the state where you are requesting credit terms.

Business Type(Required)

Federal Employer I.D. No.(Required)

Principals

Principal Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Principal Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Authorization and Guarantee

I/We individually, and as an officer or officers of the firm, hereby authorize Adams Publishing Group to publish advertising or printing for the above and I/we also guarantee payment in accordance with the credit terms. The above information is given for the purpose of obtaining credit and is warranted to be true.

I agree to the above terms

Individually and as an officer of the firm(Required)

Finance Charges

A service charge of 1.5 percent per month on the unpaid balance will be added on bills unpaid by the last day of the month in which the bill is due. This is a finance charge at the annual percentage rate of 18% per year.

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