CREDIT APPLICATION
Attention: Sales Department
NOVA Group, Ltd.
2800 Gallows Road, Vienna, VA 22180-7445
703.573.0400 fax703.876.9100
Company Name: Telephone:
Address: Suite:
City: State: Zip:
Your E-mail Address:
Nature of Business:
Length of Time in Business: Individual Partnership Corporation Other
President/Owner: Contact: Title:
REFERENCES

Bank: Address:
Officer: Telephone: Acct #:

Bank: Address:
Officer: Telephone: Acct #:

Business: Address:
Contact: Telephone: Acct #:

Business: Address:
Contact: Telephone: Acct #:

TO BETTER SERVE YOU

Account Paid By: Local Office Home Office
Home Office Name:
Address:
Accounts Payable Contact: Telephone:
Estimated Number of Deliveries: Weekly Monthly

This application for credit is hereby made and the above references givenwith the understanding that this information will be held in strictestconfidence. Furthermore, we understand that the terms are payment withinthirty days of billing date. A service charge of 1.5% (18 APR) is added toany account with an outstanding balance exceeding 30 days. NOVA Group, Ltd.and its affiliated companies reserve the right to suspend service to any account with an overdue balanceuntil the account is current.
Signed: Title: Date:
(Please complete, print, sign and return to above address or fax.If faxed, an original signed copy must be sent by mail.)
NOTES____________________ APPROVED_______ DENIED_______ BY_____ DATE__________

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