Business Name:
	Parent Company Name:
	Billing Address:
	City:	State:         Zip:
		Only fill out street address if billing address is different.
	Street Address:
	City:	State:         Zip:
	Phone:	Fax:
	HALO Sales Representative:
	Credit Limit Requested:

	Type of Organization:	Partnership      Corporation         Gov't Non Profit        Proprietorship      Other
	Name of Owner(s)   or Corporate Officers:
	Month and Year Established:	/       D&B Number (if known):
	State Sales Tax Status:	Number:        Exempt:        Taxable:
	Accounts Payable Contact:
	Contact Email Address:
	Contact Phone:
		If your company is tax exempt, please fax applicable tax exemption certificate with your signed credit application.

	Additional Notes:

	I hereby certify that the information listed above and/or attached is warranted to be true. I authorize HALO Branded Solutions to investigate the above bank and trade references to obtain credit information. Should a credit availability be offered, applicant understands and agrees: to pay all charges within payment terms as stated on each invoice; that invoices not paid within HALO Branded Solutions payment terms as noted on the invoices are subject to late payment fees of 1.5% per month; that all necessary collection and reasonable legal fees may be charged to applicant in the event of default or failure to pay for goods sold and delivered.
	After you click "Submit", you will see a copy of your credit application. Please review this page for accuracy.
	Name:	Title:
	Signature:	__________________________________________________      Date: