LNP Business Information Form

Business Information Form

General Information

Business Name

Address

City

Zip

Business Contact for Payment

Name

Title

Telephone

E-mail

Company Mailing Address (if different from above)

Mailing Address

City

State

Zip

Names and Titles of Principals

Principal - Name and Title

Company Tax ID #

Tax ID

The undersigned ("Customer") certifies the above information to be true and accurate and authorizes LNP Media Group, Inc., 8 West King Street, Lancaster, PA 17608 to obtain the necessary Credit and/or Financial information required for the extension of Credit Terms. The above information will be used solely for the purpose of establishing credit with LNP Media Group, Inc. and will not be shared. Customer acknowledges Payment Terms as stated on the LNP Media Invoices, Statements, and Billing Documents. Customer agrees to pay reasonable Attorney's Fees and/or Legal Costs incurred in the enforcement of any claims due to non-payment of account.

I agree to the above terms of service

Please Type your Name and Title Below for use as an electronic signature

Your Name

Your Title