LapTraveler.com
Credit Application

Please print this form, provide all information requested, and return by fax or regular mail.
Fax to: 423-775-0611. Mail to: Interactive Products Corporation, 148 Bluff Road, Dayton, TN 37321.

IMPORTANT!
You must provide contact names and fax numbers.
Any application received without contact names and fax numbers will not be processed.
You must also complete the BANK REFERENCE

COMPANY PROFILE
Company Name:
 _________________________________________________________
Doing Business As:
 _________________________________________________________
Address:
 _________________________________________________________
  _________________________________________________________
  _________________________________________________________
City:
 _________________________________________________________
State:
 ________________________
Postal Code:
 ___________________
Country:
 ________________________
Contact:
 ________________________
Phone:
 ___________________
E-mail:
 ________________________
Website:
 ___________________
Year Established:
________________________
    
Business Type:
 ________________________    
# of Branches:
 ________________________    
# of Salespeople:
 ________________________    
OWNER INFORMATION
Name:
 _________________________________________________________
Home Address:
 _________________________________________________________
  _________________________________________________________
City:
 _________________________________________________________
State:
 ________________________
Postal Code:
 ___________________
Country:
 ________________________
Social Security No:
________________________
Home Phone:
 ___________________
CREDIT REFERENCES
Reference 1:
 _________________________________________________________
Address:
 _________________________________________________________
  _________________________________________________________
Contact:
 ________________________
Phone:
 ___________________
Credit Limit:
 ________________________
Fax:
 ___________________
Reference 2:
 _________________________________________________________
Address:
 _________________________________________________________
  _________________________________________________________
Contact:
 ________________________
Phone:
 ___________________
Credit Limit:
 ________________________
Fax:
 ___________________
Reference 3:
 _________________________________________________________
Address:
 _________________________________________________________
  _________________________________________________________
Contact:
 ________________________
Phone:
 ___________________
Credit Limit:
 ________________________
Fax:
 ___________________
PROPRIETOR GUARANTEE
By signing this Application, I acknowledge that I have personally guaranteed the debts and obligations of my business and agree that I am personally obligated to perform all of the terms of, and make all payments to Interactive Products Corp. required by the agreement of which this Application is a part. I also authorize the listed credit references to release any information regarding my credit history.
Authorized Signature:
 ________________________
Date:
 ___________________
How did you find us? _________________________________________________
 
Thanks, and we look forward to doing business with you!