Registrant Information
*Name: Accounts Payable Contact:  (if different) *Company Name:  *Billing Address: *City:   *State:   *Zip: Shipping Address:  (if different)                                      City:                                   State:    Zip:   *Phone:  Fax: *Email: Membership Number:        *Please Check One:   Individual    Partnership   Corporation                                           Other
Trade References:
1	Name:
	Account:
	Phone:
2	Name:
	Account:
	Phone:
3	Name:
	Account:
	Phone:
Terms of Sale and Agreement Applicants who receive summary bills agree to pay all monies due within 10 days from date of invoice.  Applicants who receive daily invoicing agree to pay all monies due within 30 days of invoice date.  Should applicant default on terms and legal action becomes necessary, the applicant agrees to pay all collection expenses including administrative costs, court costs and attorney fees.  Applicant will inform Corporate Express of any change in company name, address or phone number as soon as such changes occur.  The information given is warranted to be true and Applicant authorizes the release of all pertinent informaiton necessary for processing the applicant's request for credit including bank records or other financial data. *  I have read the terms and accept them.
*   Indicates required fields.
If paying by check, make check payable to NABR, and mail to: National Association for Business Resources 27700 Hoover Road - Suite 100 - Warren, MI 48093 Phone: 866-321-1822 Fax: 586-393-8810