APPLICATION FOR CREDIT

(Please Type or Print)

Company Name:___________________________________________________________ Date: __________

Contact: ____________________________ Phone: _____________________ Fax: __________________

Street Address: ____________________________________________________________ Suite: ___________

City: _______________________________ State: ___________ Zip Code: _____________

Invoices to be sent to: ____________________________________________________________________

Business Established: __________________________________ (date)

Bank References: Please attach authorization (on company letterhead) for Nova Label to check bank references.

Name & Branch Account Number Telephone & Fax

__________________________ ______________ _________________phone _________________fax

__________________________ ______________ _________________phone __________________fax

Trade References: List local businesses with whom you have dealt.

Name & Address Telephone & Fax

1. _______________________________________ ______________________________telephone

___________________________________________ ____________________________fax

2. _______________________________________ ____________________________telephone

___________________________________________ ____________________________fax

3. _______________________________________ ____________________________telephone

___________________________________________ ____________________________fax

4. _______________________________________ ____________________________telephone

____________________________________________ ____________________________fax

Are you sales tax exempt? _________ Tax exemption # __________________

A COPY OF TAX EXEMPTION CERTIFICATE MUST BE ATTACHED

Authorized Signature: __________________________________________ Title: ____________________

IMPORTANT: THIS FORM MUST BE COMPLETELY FILLED OUT TO AVOID DELAY.