Application for Credit

Today Media Inc.
3301 Lancaster Pike, Suite 5C
Wilmington, DE 19805
(302) 656-1809
Fax (302) 656-5843

New Account
Payment Required for First Insertion

Date	/ /
Sales Person
Client

Company Name

Business Address

Billing Address if Different

Business Telephone Type of Business

Type of Ownership:

Corporation Partnership Individual

Years Established

Years Incorporated

Names(s) of a Proprietor/Partner, if a Corporation President/Treasurer:

Name of Proprietor	Social Security Number
Residence	Phone No.
Name of Proprietor	Social Security Number
Residence	Phone No.

Individual to contact regarding payment

Individual authorized to place advertising

Business Banking references:

Bank	Branch	Type of Acct. and No.
Bank	Branch	Type of Acct. and No.

2. ADVERTISING MEDIA AND 1 VENDOR WITH WHICH YOU HAVE ESTABLISHED CREDIT

Co. Name	Tel. No.
Address	Acct. No.
City
Co. Name	Tel. No.

Address	Acct. No.
City
Co. Name	Tel No.
Address	Acct. No.

City

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What is 7 + 7?

Application for Credit

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