INTERNATIONAL PIANO SUPPLY CREDIT APPLICATION

Upon completion, please mail or fax to: IPS, Inc. 88 NewOctave Loop, Box 1005, Astoria, OR 97103-1005 USA
Fax: 1-503-325-0860

The information requested below will be held in the strictest of confidence by our firm. It is used for the sole purpose of extending credit. We respect your privacy and will not violate your trust by sharing information provided us for that purpose.   In the event that your account should become seriously delinquent, we do reserve the right to divulge information provided us for collection purposes, as necessary.

PLEASE PRINT CLEARLY
 
Name:___________________________________________________
 
Address:____________________________________________________________________________________
 
City:___________________________________State/Province:_______________Postal Code:__________
 
Country:_________________________Phone:_____________________________________
 
Email Address:______________________________
 
 
BANK REFERENCE 
Where do you bank?______________________________________
 
Address:___________________________________________________________________________________
 
City:___________________________________State / Province:___________Postal Code:___________
 
Country:_________________________Phone:_____________________________________
 
Checking Account Number:____________________________

TO HELP EXPEDITE PROCESSING OF YOUR APPLICATION, YOU SHOULD INFORM YOUR BANK THAT OUR BILLING DEPARTMENT WILL BE CONTACTING THEM FOR A RATING ON YOUR ACCOUNT. MANY INSTITUTIONS WILL NOT RELEASE THIS INFORMATION WITHOUT YOUR SIGNATURE OR VERBAL AUTHORIZATION.

 
Valid credit card held with:__________________________________ 
(VISA/MC/DISCOVER) 
 
Address:___________________________________________________________________________________
 
City:___________________________________State / Province:___________Postal Code:___________
 
Country:_________________________Phone:_____________________________________
 
Account Number:________-________-________-________Expiration Date_____/_____  
 
                       Security ID _______ 
(this is the 3-digit code on the signature line on the back of your card)
(we require a valid credit card to be held on file for all open billing accounts
– this would only be charged in the event of overdue balances of 60 days or more)
 
TRADE / CREDIT REFERENCE
 
Company Name:_________________________________________ 
 
Address (if different than above):__________________________________________________________
 
City:___________________________________State/Province:________________Postal Code:_________
 
Country:_________________________Phone:_____________________________________
 
Account Number:___________________________________
 
 
TRADE / CREDIT REFERENCE
 
Company Name:_________________________________________ 
 
Address:__________________________________________________________________________________
 
City:___________________________________State / Province:___________Postal Code:__________
 
Country:_________________________Phone:_____________________________________
 
Account Number:________________
 

OPEN ACCOUNT BILLING TERMS:

A minimum of $500.00 in accumulated purchases per annum must be maintained to keep your account open – no exceptions. Full payment on an open invoice must be received by us within 15 days of the original shipping date of your order (20 days for orders shipped outside the U.S.). Finance charges will accrue at a rate of 1.65% / month for any and all overdue amounts. Additionally, a late charge of $7.50 will be applied beginning on the 16th day beyond the date of an open invoice and again every 15 days until paid in full. Should any payment be received late more than once, all credit privileges may be permanently suspended. Invoices billed on your account are payable by check or money order in U.S. funds only (unless other arrangements have been made in advance). Any instrument presented for payment which is returned by your bank for any reason will be charged a $20.00 processing fee. Any balance(s) owing which is later elected or automatically converted to credit card billing after 60 days will be charged a 5% handling fee. Should we find it necessary to seek legal or other remedy to collect on an unpaid account for which you are responsible, you hereby agree to be liable for all costs we expend for such purpose including, but not limited to, collection costs, legal and court fees plus interest on our outlays at a rate of 10% per annum.

By signing below, you are applying for credit with International Piano Supply (IPS) and fully acknowledge financial responsibility for any and all debts incurred when ordering merchandise on credit as described above.
I hereby agree to be held to the terms described herein. I further authorize IPS to charge any overdue balances of 60 days or more to my credit card (if a company/corporate credit card, signer affirms under penalty of perjury that they are authorized to bind the company represented) including late/finance charges as described above, without recourse.

Name (print):___________________________________________  
 
Signature:__________________________________________________  
 
Date:_____________________

In most cases, your application will be processed within 3 business days.  
 
Thank you for allowing us to be of service.
Questions regarding credit or this application may be directed to: 
ips@pianosupply.com or by calling 1-503-325-0555
©2008 International Piano Supply, Incorporated