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Company Name & Location

Name: Company: Address: Phone:    Fax: Email:

Billing Address (if different)

Company: Address: -Same-

Company Ownership Information

Type of Business: Corporation Partnership Sole Proprietorship Individual State Incorporated: Date Bus. Started: Nature of Business:

Principal or Officer Title S.S.# 1 2 3

Banking & Finance Reference

Bank Name: Address: Account Numbers Checking: Savings: Dun & Bradstreet#:

Trade References

Company Name Contact Phone # 1 2 3

ALL INVOICES ARE DUE AND PAYABLE 10 DAYS AFTER RECEIVED UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE IN ADVANCE. INVOICES ARE ISSUED AT THE FIRST AND THE 16TH OF EACH MONTH. PAST DUE BALANCES WILL BE CHARGED 1.5% INTEREST PER MONTH. SECURITY COURIERS, INC. WILL NOT BE RESPONSIBLE FOR THE COST OF ANY ITEM NOT DECLARED AT THE TIME THE ORDER IS PLACED. OUR LIMIT OF LIABILITY IS $250.00 PER DELIVERY. (THE ABOVE INFORMATION IS SUBMITTED FOR THE PURPOSE OF OPENING AN ACCOUNT OF WHICH PAYMENT IS GURANTEED BY THE COMPANY AND IT'S OFFICERS)