APPLICATION FOR CREDIT
FULL LEGAL NAME OF ADVERTISER:
1801 SUPERIOR AVENUE, CLEVELAND, OH 44114/216-999-4040/216-515-2551 FAX
_________________________________________ DBA: ___________________________
MAILING ADDRESS:
_______________________________
CITY: _____________________ STATE: ________ ZIP CODE: ____________
BILLING ADDRESS:
_______________________________
CITY: ______________________ STATE: ________ ZIP CODE: ____________
TELEPHONE:
____________________________________
PARENT COMPANY:
________________________________
ADVERTISER PROFILE:
CORPORATION
FAX:
PARTNERSHIP
__________________________________________
WEBSITE:
LIMITED PARTNERSHIP
_______________________________________
LIMITED LIABILITY PARTNERSHIP
SOLE PROPRIETORSHIP
YEAR REGISTERED WITH SECRETARY STATE: _____________ STATE REGISTERED:_______________ NATURE OF BUSINESS: _________________
NO. OF EMPLOYEES: _______________
ANNUAL SALES: $ ________________
FEDERAL TAX IDENTIFICATION NO.: ___________________
OFFICERS/PRINCIPALS
NAME: ____________________________________________ TITLE: _________________ SOCIAL SECURITY NO.: __________________________
HOME ADDRESS: __________________________________ CITY: __________________________ STATE: __________ ZIP CODE: ____________
HOME PHONE: ___________________________
FAX NUMBER: ___________________________ EMAIL ADDRESS: _________________________
NAME: _____________________________________________ TITLE: ________________
SOCIAL SECURITY NO.: __________________________
HOME ADDRESS: __________________________________ CITY: __________________________ STATE: __________ ZIP CODE: ____________
HOME PHONE: ___________________________
MEDIA CREDIT REFERENCES:
FAX NUMBER: ___________________________ EMAIL ADDRESS: _________________________
(NEWSPAPER, RADIO, TELEVISION, MAGAZINE)
NAME: ___________________________________________
ACCOUNT NUMBER: ___________________
PHONE NUMBER:__________________
ADDRESS: ________________________________________ CITY:___________________________ STATE: __________ ZIP CODE: ____________
NAME: ___________________________________________
ACCOUNT NUMBER: ___________________
PHONE NUMBER:__________________
ADDRESS: ________________________________________ CITY:___________________________ STATE: __________ ZIP CODE: ____________
NAME: ___________________________________________
ACCOUNT NUMBER: ___________________
PHONE NUMBER:__________________
ADDRESS: ________________________________________ CITY:___________________________ STATE: __________ ZIP CODE: ____________
BANK REFERENCES:
CHECKING
SAVINGS
LOAN
NAME:____________________________________ BRANCH:__________________________________ ACCOUNT NUMBER: ____________________
PERSONAL GUARANTEE
To induce Northeast Ohio Marketing Network, LLC to accept the above contract, I assume personal and individual responsibility and liability for payment
under the contract and I personally guarantee the complete performance by Advertiser of all of its obligations and prompt payment of all bills
thereunder. The undersigned consents to Northeast Ohio Marketing Network, LLC obtaining a consumer credit report on
____________________________________________________________ in order to extend credit in connection with this application.
GUARANTOR NAME
____________________________________________________
SIGNATURE OF GUARANTOR
_____________________________________ _____________
PRINT NAME
DATE
THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE ARE PART OF THIS APPLICATION
ADDITIONAL TERMS AND CONDITIONS
1.
Applicant agrees to pay for all advertising charges on its account by any of its
representatives, agents and employees.
2.
Applicant agrees to pay for any and all advertising per payment terms shown on
the Publisher’s invoice.
3.
Any bill tendered by Publisher shall be conclusive as to the correctness of the
item(s) therein set forth and shall constitute an account stated unless written
objection is made thereto within ten days from the rendering thereof.
4.
Accounts not paid within sixty (60) days of the due date are considered delinquent
and subject to suspension of credit privileges.
5.
Credit granted to the Applicant may, at the option of the Publisher, be canceled at
any time.
6.
Applicant acknowledges that the sales personnel of Publisher are not authorized
to negotiate, alter, amend or change any of the terms of any agreements made by
Publisher’s Credit Department.
7.
Upon request the Applicant will provide Publisher a full and complete financial
statement.
8.
Applicant shall give Publisher thirty (30) days written notice before any changes in
its ownership and shall give Publisher prompt notice of any other material change
in the information contained on the front of this application. Such notice shall be
directed to the attention of the Credit Manager.
9.
Any terms and conditions contained in any insertion order different than the
Publisher’s terms and conditions are not part of this agreement.
10.
All terms and conditions shall be governed by the laws of the state of Ohio.
11.
If it becomes necessary to place with an attorney for collection for any funds due
then Applicant agrees to pay to the Publisher a reasonable fee of twenty-five (25)
percent of the balance then unpaid.
12.
All invoices which are not paid by their due date are subject to an interest charge
of 1 ½ percent per month.