Glass Graphics Specializing in Corporate Gifts and Awards

Specializing in Blank Glass & Engraved Glass Products

Please be sure to fill in the application completely to ensure the fastest response.

- Account Application Form - * These are required fields

Part I: Business Information

Date:
Business Name: *
ASI # *
Type of Business:	Corporation LLC Partnership Proprietorship
Bank of Record:
Name:
Contact:
Account #:

Physical Address:
Street:
City:
State:
Zip:

Part II: Contact & Mailing Information


(1) Main Contact		(2) Accounts Payable Contact
Name		Name
Position		Position
Mailing Address		Mailing Address
City		City
State		State
Zip		Zip
Phone *		Phone
Fax		Fax
E-mail *		E-mail

Part III: Trade References (5 required)

1.Company	Account #	Fax
2.Company	Account #	Fax
3.Company	Account #	Fax
4.Company	Account #	Fax
5.Company	Account #	Fax

Part IV: Acknowledgement

The undersigned certifies that all information in this registration form is complete, factual, and correct. Glass Graphics will rely on the accuracy of this information for the purpose of establishing your account and determining any credit terms that may be extended. In signing this registration form the signatory hereby authorizes Glass Graphics to contact any parties listed herein to verify the information contained in this form.

Authorized Signature: *
Title of Signatory:
Date:

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Glass Graphics
Specializing in Blank Glass & Engraved Crystal and Glass Awards and Gifts