Credit Application for Businesses

THESE ARE ALL REQUIRED FIELDS.

Please fill out the following form and then press Submit. This will send us a digital version of the form, but your application cannot be fully processed until we receive a printed copy of the signed and dated application. Please print, sign and date it.
Then either (1) mail it to Stony Run Publishing, P. O. Box 334, Grantham, PA 17027 OR (2) scan & email it to info@stonyrunpublishing.com . We do not accept FAXED forms.

Bookstore Name
Date
Address
Telephone
-
City
State/Province Zip/Postal Code
Owner/Manager
Email
Business References
1. Name
Telephone -
Address
City
State/Province Zip/Postal Code
2. Name
Telephone
-
Address
City
State/Province Zip/Postal Code
3. Name
Telephone
-
Address
City
State/Province Zip/Postal Code
Bank Reference
Bank Name
Bank Account #
Bank Representative
Telephone -
Address
City
State/Province Zip/Postal Code
Credit line requested
$ (US)
The undersigned authorizes inquiry regarding credit information and acknowledges that authorized credit privileges may be
withdrawn at any time.
Signature
___________________________________________ (Bookstore Representative)
Position
Email
Signature not required on online version. After you press Submit, please print out the form. Then sign and date it and either (1) mail it to Stony Run Publishing, P. O. Box 334, Grantham, PA 17027 OR (2) scan & email it to info@stonyrunpublishing.com. Your application cannot be fully processed until we receive your signed and dated version. We do not accept FAXED forms.
=