Company Name:
________________________________________________________________
Billing Address:
_________________________________________________________________
City:__________________________ State:___________ Zip:_____________
Country:_______
Shipping Address
if different than above:
____________________________________________
City:__________________________
State:________ Zip:_____________
Country:__________
Phone:
______________________ Fax: ____________________ E-mail:
________________
Website:
________________________________________ Date Established:
_____________
Type of Business:
____________________________________ Tax ID:
__________________
Years at Present Location: _________ Owned:
____ Leased: ____
Owner:
__________________________________ Book Buyer:
_________________________
Accounts Payable:__________________ Do
you accept back orders? Yes: _____ No: ______
Type of Bookstore:
____________________________________ Store Size:
________ Sq. Ft.
Revenue Size: 0-25,000 __
25,000-50,000 __ 50,000-100,000 __
100,000+ __
Customer Class: Catholic: ____
Fundamentalist: ____ Messianic: ____
Mainline Evangelical: ____ Pentecostal: ____
Charismatic: ____ Other: ____
Does your store have a denominational stance?
__________________________________
What is your store's main ministry?
______________________________________________
Are your customers mainly male or female?
Male: ___ Female: ___
What is the average age group of your customers?
_______________________________
Bank Reference:
Name of Bank: _________________________ Account #:
______________
Address:
___________________________City: _________________ State: ____ Zip:
_______
Contact:
_____________________________________Phone Number:
____________________
Trade References: Please give
names and account numbers of 3 US book industry trade references
with
which you are currently doing business.
1. Company Name:_____________________________ Account
Number: ________________
Phone Number:
________________________ Fax Number:
___________________________
2. Company Name: _____________________________ Account Number:
_______________
Phone Number:
__________________________ Fax Number:
_________________________
3. Company Name: ______________________________
Account Number: ______________
Phone Number:
____________________________ Fax Number:
_______________________
I authorize Bridge-Logos to use this information to establish a credit
rating for me.
Name (please print):
______________________________________ Title:
_______________
Authorized Signature:
_____________________________________ Date:
______________ |