Business Credit Intelligence/NACMNE Online Application & Agreement

* Denotes a Required Field

Company Information
Company Name*:   DBA/Trade Name:
Address:*
City:*			State:*	Zip Code:*
Website:*
Headquarters Address:                  check if the billing/headquarters address is the same as above
Address:*
City:*			State:*	Zip Code:*
Industry:*			SIC code:*
Type of Business:*		Manufacturer Wholesaler Distributor Service Provider Retailer Financial Services Other	Company's Fiscal Year End:*
Importer/Exporter of Goods & Services:*		Importer Exporter Not Applicable	Years in Business:*
Products & Services Sold:*			Legal Structure:*	Corporation S Corp Proprietorship Partnership LLC
			Public/Private:*	Publically Traded Privately Held
Sales Region:*		New England Area Northeastern US Nationally Internationally	# Customer Accounts:*
Annual Sales* Revenue:		Under $5 million $5 million - $15 million $15 million - $25 million $50 million - $100 million Over $100 million	Company A/R System:*	SAP Oracle Eclipse MAS90 Peachtree PeopleSoft Custom Other:
Does your company submit A/R electronically to any credit bureaus or reporting agencies?*				Yes No
My company is interested in joining an industry credit group: *				Yes No

Company Contact Information
Contact Name:*		Phone::*
Title:*		Fax:*
Professional Designation:*	Certified Business Associate (CBA) Certified Business Fellow (CBF) Certified Credit Executive (CCE) Master in Business (MBA) Certified Public Accountant (CPA) FCIA Attorney (Esq)	Email:*
Years in Credit Profession*:		# of Credit & Collections Staff:*
Is your company interested in a corporate membership?			Yes No
Financial Officer/Controller:*		Email Address:

Terms and Conditions

Upon receipt, your application will be reviewed.  Applications accepted will be processed and an invoice will be sent to you.  Once payment is received in full, your access to our services will be activated.  I understand that company fees for products and services are due upon invoice.  Annual service fees for membership and groups are set at the prevailing rates, are subject to change and continue from year-to-year unless notice of cancellation in writing is given at least 30 days in advance of annual renewal date.  I understand that there are no refunds, including fees for unused services.   Any amount past due is subject to a monthly 1.5% finance charge. The applicant hereby agrees to pay interest or late charges on all unpaid invoices for products and services from the date due until all sums are paid in full, at the lesser of one and one half percent (1-1/2%) per month, compounded monthly, or at the highest contract rate allowed by law. All costs of collections, before and after judgment, including but not limited to court costs, interest and reasonable attorney fees.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age: because all or part of the applicant’s income devices from any public assistance program: or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission. 

The applicant certifies that the statements contained in the application are accurate and that he/she has the authority to execute this agreement on behalf of the applicant company.

                                                *   I agree to the Terms & Conditions:   Yes   No*

Signature/Title: *

                  Date:  *

Thank You.  We will contact you shortly regarding your application.