Click here if you prefer to print,
fill-out and fax your application to us.
 General Information
 Account Interest
Contact Name:
 
Reprographics
Color Graphics 
Contact Email: *
 
Supplies
Equipment 
Date:
 
Other    
Account Rep:
 
 
 
 

* Note: A current e-mail address is required to process this application.
If you have no e-mail address please enter: credit@accentimaging.com
 
 Billing Information
 
 Shipping Information
Company
 
Same as Billing:
 
Contact/ Title
 
Address
Address
 
City
City
 
State
State
 
County
County
 
Zip
Zip
 
Phone/Extension
Phone/Extension
 
Fax
Fax
 
 
 
 
 Company Information
 
 Bank References
Type of business or service
 

Bank Name:

Number of years in Business
 
Account No. 
Dunn & Bradstreet Rating
 
Address: 
Tax Exempt?    Yes   No    1%
If yes, fax copy of certificate to 919-783-0702
 
 Phone: 
Is the account to be administered by a purchase order system?
Yes  No
 
 
         
 Current Trade References
 
 Current Trade References
Name:
 
 Name:
Contact:
 
 Contact:
Account #:
 
 Account #:
Phone #:
 
 Phone #:
Address:
 
 Address:
City:
 
 City:
State:
 
 State:
Zip:
 
 Zip:
 Additional Information
 

TERMS:

Accent Imaging, Inc. account terms are NET 30. All accounts are due and payable according to the terms stated on the invoice. A service charge of 1-1/2% per month will be charged on all outstanding balances over 60 days from the date of the invoice. This is an annual interest rate of 18%. All accounts over 60 days are automatically placed on C.O.D. until they are made current. All costs incurred for collection, including reasonable attorney fees, will be the responsibility of the applicant.

By submitting this application, I acknowledge that I have read and understand the terms that are outlined above and hereby certify that the applicant unconditionally agrees to abide by them.
 


Accent Imaging, Inc., 8121 Brownleigh Drive, Raleigh, NC 27617
phone: 1-800-280-0755 or 1-919-782-3332
fax: 1-919-783-0702
info@accentimaging.com