EDUCATIONAL SCIENCE WHOLESALE ACCOUNT APPLICATION
BUSINESS CERTIFICATION QUESTIONNAIRE

Please fill out or correct the information below, then press 'Submit Form' at the bottom of the page.

BILL TO:   Business Name:
  Contact Name:
  Street Address:
  City: State/Prov:   Zip:   Country:
  Office Phone:       Fax:       Email:

SHIP TO:   Click if same as BILL TO: ; otherwise enter SHIP TO address below
  Business Name:
  Contact:
  Street Address:
  City: StateProv:   Zip:   Country:
  Phone:       Fax:       Email:
Website Address:
Tax Exempt Number:          DBA Number:


Type of Ownership:   -Partnership    -Corporation    -Sole Proprietor
Year Business Started:      Year Incorporated:
Principles/Owners Position/Title Home Address Home Phone

Bank Information:    Bank Name:
Address:
Phone:     Contact:
Check Acct:     Savings Acct:

Trade Information: (Please provide a minimum of 3 references)
Name:
  Address:
  Phone:     Fax:     Acct No:
Name:
  Address:
  Phone:     Fax:     Acct No:
Name:
  Address:
  Phone:     Fax:     Acct No:

Minimum wholesale order is $100.00 All orders are C.O.D. until the credit application has been approved. Terms on approved accounts shall be Net 30 days from date of invoice, unless otherwise agreed upon prior to shipping. The balance of the account remaining unpaid after 30 days from date of invoice shall be subject to a late charge of 1.5% per month for each month or part thereof.

Prices do not include Federal, State, or Local sales or similar taxes or assessments on goods sold. Any such tax shall be separately itemized on Educational Science's invoice and paid for by the buyer. In lieu thereof, the buyer shall furnish Educational Science with a valid tax certificate. Buyer shall pay any and all other expenses and costs incurred in the collection of buyer's unpaid and delinquent bills owed to seller including attorney's fee and expenses

By entering a name below, the applicant gives permission to Educational Science to verify credit history and information. All information acquired during the credit approval process will be held in strict confidence.

Applicant's Name:
Title:     Date:
(Office Use Only):