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NEW CUSTOMER ACCOUNT APPLICATION

Upon completion, please email to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Please choose the type of account you desire to set up with us:

______ CONSTRUCTION/ARCHITECT

______ CORPORATE/BUSINESS

______ EDUCATION (K-12)

______ EDUCATION (University)

______ OTHER Please Specify: _________________________________________________

Business Name
Type of Ownership	____ Corporation ____ Partnership ____Sole Proprietorship
How long have you been in business?
Business Mailing Address *Please attach separate sheet listing other business locations if necessary		Business Ship to Address *Please attach separate sheet listing other business locations if necessary
Main Telephone		Secondary Phone
Email:		Fax

Main Contact		Phone
Email:		Fax

Purchasing Contact		Phone
Email:		Fax

Accounting Contact		Phone
Email:		Fax

Please list other members & their respective titles and contact information that are authorized to initiate, purchase or otherwise do business on your entities behalf (attach page if necessary):

Name		Phone
Email:		Fax

Digital Communications and Display, LLC offers 2 Account types. You will be required to keep an active credit card on file even if you are choosing an Open Account (Net 20). We will not charge your card without your permission.

What kind of account do you wish to set up?

_____ Credit Card

_____ Net 20/Open Account

Credit Line Amount Requested: ______________________________ (Subject to approval)

Digital Communications & Display, LLC charges a late fee of $2.00 per business day on all past due accounts. Please initial as a testament that you understand and agree to these terms: _____________________

Please provide the following financial information if you have selected “Net 20/Open Account” for your account type. By providing this information, you authorize Digital Communications and Display, LLC to contact your bank for average balance, returned check information, etc.:

Bank Name
Bank Address	Street Address
	City, State & Zip
Account Contact			Phone
Fax			Email:
Account Type		Checking Savings	Account #
How long have you been banking with this bank?
Please sign as authorization to contact the above bank:		X:		Date:

TRADE REFERENCES:

Please provide the following account information if you have selected “Net 20/Open Account” for your account type. By providing this information, you authorize Digital Communications and Display, LLC to contact the below businesses (2 required) for average open balance, returned check information, non-payment, etc.:

REFERENCE #1:

Business Name
Business Address	Street Address
	City, State & Zip
Account Contact			Phone
Fax			Email:
Account Type			Account # Or Customer #
Please sign as authorization to contact the above business:		X:		Date:

REFERENCE #2:

Business Name
Business Address	Street Address
	City, State & Zip
Account Contact			Phone
Fax			Email:
Account Type			Account # Or Customer #
Please sign as authorization to contact the above business:		X:		Date:

Are you tax exempt in any way?

Please describe below along with submitting your tax certificate.

Digital Communications and Display, LLC will charge appropriate sales tax if your certificate is not on file!

Tax Exemption Type:
Certificate Number:

FEIN or SSN:

Credit Card Information (Required)

Card Type
Name on Card
Card Number
Expiration Date
CVC Code (3 digits on back or 4 on front if AmEx)
Signature of Cardholder	X
Billing Address of this card

Did you remember?

-To Sign all yellow boxes?

-To attach any additional documents (other business locations, tax certificate, etc.)

Thank you for your interest in our company. If you have any questions or concerns, please do not hesitate to contact us immediately. Upon receipt, it may take up to 2 business weeks to finalize your account. This is due to response times from the listed firms that we must contact to establish terms with you. You will contacted via email with our decision.

We never sell or share our customers information!

How can we contact you for more information if needed?

Name:

Position:

Email:

Phone:

Fax: