Credit Application

New customers who would like to receive an invoice for AGI's services must complete a credit application. Please fill out the following form and submit it to us electronically, or fill out the PDF version of the application and fax it to 202-371-5488.

Please note: This is not a secure online form.

If you have questions or concerns, please call us at 202-371-5484.
 
* Denotes required field.
 
*Amount Requested:
*Name of Business:
(Legal Name)
*Employer Id Number:
*Kind of Business:
(activities engaged in)
*Time in Business:
 
*Type of Business: Sole Owner
Partnership
Corporation
 
*Date Incorp.: format (mm/dd/yyyy)
*State:
 
*Business Address:
 
*City:
*State:
*Zip:
*How Long at This Address?:
*Business Telephone:
*Fax:
*Accounting Dept. Contact:
*Special Billing Requirements:
*Bank Reference:
*Address or Branch:
*Contact:
*Accounts:
 
 Account 1:
 Type:      Account # :  Bank Phone:
 
 Account 2:
 Type:     Account # :   Bank Phone:
 
*List of Owners/Officers:
 
 *Owner/Officer 1:
Name:
Title:
Home Address:
 
Social Security:
 
 Owner/Officer 2:
Name:
Title:
Home Address:
 
Social Security:
 
 Owner/Officer 3:
Name:
Title:
Home Address:
 
Social Security:
 
*Three Local Trade References:
 
 *Reference 1:
Name:
Address:
 
Type of Business:
Phone Number:
Fax:
 
 *Reference 2:
Name:
Address:
 
Type of Business:
Phone Number:
Fax:
 
 *Reference 3:
Name:
Address:
 
Type of Business:
Phone Number:
Fax:
Has the business recently filed a financial statement with a bank?
Yes No
If Yes:
Bank Name:
Branch of Bank:
Dun and Bradstreet No.:
 
Have you or the business ever had a business failure or filed any type of bankruptcy proceeding?    Yes     No
 
If Yes, explain:
 
*AGI Sales Rep:
 
Please note: This is not a secure online form.
 
 
© 2006 Automated Graphic Imaging, Inc
1090 Vermont Avenue NW, LL, Washington, DC 20005
(202) 371-5484 • Fax (202) 371-5488 info@agidc.com
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