Items marked with an asterisk (*) are required.

* Email address:  
* Business Name:  
* Address:  
* City:   * State: * Zip:
* Contact Person:   * Phone:
Years in business:  
* Type of business:   Corporation Partnership Proprietorship

List the Full Name, Position, Address & Phone Number of Owner(s), Partner(s) or Corporate Officers. (Must include address and phone number for each owner if different than above.)
* Name * Position Address Phone
  
  

Previous business names operated:
1:  
2:  

* Nature of business:  

* Currently listed with Dunn and Bradstreet?  
Yes No           DUNS #

* Amount of Credit requested:         $

* Bank reference:   Name:
Address:
Account No.:
Contact Person:
Contact Phone:

Credit References (Include Media references if available):
* 1.   Company name: Phone No.:
Contact name:
  Address: Account No.:
 
   2.   Company name: Phone No.:
Contact name:
  Address: Account No.:
 
   3.   Company name: Phone No.:
Contact name:
  Address: Account No.:
 
   4.   Company name: Phone No.:
Contact name:
  Address: Account No.:
 
* Name of Person(s) authorized to place advertising:

Remarks (Any other  
pertinent information):  

By submitting this electronic application, I certify that the above information is true and correct to the best of my knowledge and is being provided to Capital-Gazette Newspapers for the sole purpose of extending credit or the re-evaluation of my account. If credit is extended, the undersigned agrees to pay the Capital-Gazette Newspapers, according to their credit terms as stated below and those set forth on the rate card, at their offices in Annapolis, Bowie, or Glen Burnie, Maryland.


* Your name * Title * Date

Payment Terms:
All bills are due and payable in full within thirty (30) days of the billing statement. If advertisers discover any discrepancies in the billing statement, CAPITAL-GAZETTE NEWSPAPERS Accounts Receivable Department must be notified in writing within thirty (30) days of the date of the billing statement. Within thirty (30) days of receipt of such written notice, CAPITAL-GAZETTE NEWSPAPERS shall review the advertiser's billing statement and notify them of any changes, modifications or corrections due to any discrepancies.

 

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Mail to: FAX to:
Capital-Gazette Newspapers
2000 Capital Drive
Annapolis, Maryland 21401 		410-268-4643

If you have questions or require additional assistance completing this form, you may contact the Credit Department at 410-268-5000 or accounting@hometownannapolis.com.