Business Application
The following information is submitted for your consideration as basis for extending open account terms to us:
All information will be kept confidential.
Personal / Business Information:
Business Name:
Your Name:
E-Mail Address:
Telephone:
Work
Mobile
Pager
Telephone:
Work
Mobile
Pager
Fax:
Type of Business:
Business Owner's Name:
Business Address:
City:
State:
Zip Code:
Business References:
I/We have open account privileges with the following:
Credit Reference #1:
Contact Telephone:
Credit Reference #2:
Contact Telephone:
Credit Reference #3:
Contact Telephone:
Bank Information:
Bank Name:
Officer's Name:
Bank Telephone:
Services You Require:
Hosting Plan:
Professional Hosting Plan ($195)
Professional Plus Hosting Plan ($300)
E-mail Hosting Plan ($144)
Requested Domain:
Existing Domain:
Any additional comments and requirements:
The undersigned understands that all accounts are due when billed and that IowaWebHosting.com will send a monthly statement as of the last day of each month (billing date). The undersigned further understands that if any part of the amount billed at any billing date shall remain unpaid at the next billing date, there will be a
FINANCE CHARGE
at the
PERIODIC RATE
of one & one-third (1.333) percent per month on the part remaining unpaid, regardless of the amount thereof, resulting in an
ANNUAL PERCENTAGE RATE OF SIXTEEN PERCENT (16%)
, to all of which the undersigned applicant for credit consents and agrees.
I/We have read the above statements and agree to the terms and disclosures set forth on this application.