Credit Application

BUSINESS INFORMATION

Have you already been approved for credit with Adorama? *

Yes
No

Business Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Website

Business type *

Corporation
Partnership
Proprietorship

Year Established *

ID Type *

Federal Tax ID
Social Security Number

Federal Tax ID *

Social Security Number *

OWNERSHIP INFORMATION

Full Name of Corporate Officer/Owner *

Personal Contact Info

Same as business

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email

Do You Have a Resale or Tax Exempt Certificate *

Yes
No

Upload Certificate

Click or drag files to this area to upload. You can upload up to 10 files.

REFERENCE INFORMATION

Bank Name *

Account Number *

Bank Address *

Address Line 1

Address Line 2

City

State

Zip Code

Bank Contact Name

Bank Phone *

Bank Email

Reference #1

Reference #1 Business Name *

Reference #1 Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #1 Phone *

Reference #1 Email

Your Vendor Account Number

Reference #2

Reference #2 Business Name *

Reference #2 Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #2 Phone *

Reference #2 Email

Your Vendor Account Number

Reference #3

Reference #3 Business Name

Reference #3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference #3 Phone

Reference #3 Email

Your Vendor Account Number

REQUIRED FINANCIAL INFORMATION
If requested credit line is greater than $10,000, Corporate applicants must attach most recent financial statement (audited balance sheet & income statement). Proprietor and partnership applicants must attach most recent tax return.

The Applicant certifies that the above statements are correct and agrees with the terms of sale set forth by Mitsubishi Imaging (MPM), Inc. as follows: ) All accounts are due and payable within 30 days from the date of the invoice; 2) A late payment fee of 1.5% (18% APR) will be paid by the customer on amounts not paid within terms.

Upload Most Recent Financial Statement and Tax Return

Click or drag files to this area to upload. You can upload up to 10 files.

Signature *

Clear Signature

Title

Date *