MVD Credit Application

BILL-TO ADDRESS
Company Name:
Address 1:
Address 2:
Address 3:
City:
State:
Country:
Zip Code:
SHIP-TO ADDRESS - Check if same as BILL-TO address
Company Name:
Address 1:
Address 2:
Address 3:
City:
State:
Country:
Zip Code:
 
E-Mail Address:
Phone:
Fax:
Business Structure: Sole Proprietorship Partnership Corporation
Type of business: Retail Wholesale
Account type requested: COD Co Check NET 10 Days NET 30 Days
Estimated Sales for 12 months: $
Where and when established:
Pricipals:
Names, home addresses, phones (no PO BOX)
EIN# or SS#:
Drivers Licence# and Expiration
Bank info
Bank name:
Address:
Account#:
Contact:
Three credit references in the video or recorded music sales industry:
Reference 1
Name:
Address 1:
Address 2:
Address 3:
City:
State:
Country:
Zip Code:
Phone:
Fax:
Reference 2
Name:
Address 1:
Address 2:
Address 3:
City:
State:
Country:
Zip Code:
Phone:
Fax:
Reference 3
Name:
Address 1:
Address 2:
Address 3:
City:
State:
Country:
Zip Code:
Phone:
Fax:
Please read carefully - I hereby warrant that the above information is true and correct, and is furnished for the purpose of obtaining credit for the Company. I further agree that MVD may make credit inquiries, and I consent that MVD may obtain information from credit references. I understand that if an outside collections agency or legal firm is used to collect past due balances, the Company will be responsible for the full expenses incurred.

     I have read and agree to the above:
Principal's Name:
Principal's Title:
Principal's Phone#: