Join an Industry Credit Exchange Group

Company Information

Company Name*

DBA/Trade Name

Member Number (Please enter 000 if none)*

Is your company a member of any other Credit Association? (Yes/No) If yes, please note with which association)*

Is your company a member of any other trade groups? If so, please list them and who facilitates them:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website (https://www.XXXX.com)*

Company's Fiscal Year End (MM/DD)*

Federal Id #*

Year Business Established*

Legal Structure*

Ownership Type*

Annual Sales Revenue*

Company A/R System*

Number of Customer Accounts*

Sales Region*

Importer/Exporter of Goods & Services

Type of Business*

SIC Code/NAICS Industry Classification Code (if unknown, please enter 0000)*

Is your company in one of the following industry segments?

Please list the business types/industries/channels you sell to/service:

Is your company a wholesale distributor who sells products either through their own terminal facilities or on a throughput basis, at host terminals.*

Yes
No

Does your company's rack sales exceed 4 million barrels annually in the New England, New York, New Jersey, Atlantic coast and/or the Midwest areas.*

Yes
No

Is your company part of a buying group or cooperative consisting of members who are owners or controllers of retail lumber or retail building material entities.*

Yes
No

Does your company operate a retail lumber entity?*

Yes
No

Does your company have a record of judgments, liens, attachments and/or bankruptcy filings within the past 5-years?*

Yes
No

Is your company engaged in the manufacturing of electrical related materials?*

Yes
No

Products & Services Sold*

Please provide 10 customers (Names, City, State):*

The information supplied in this company profile will be used to assess a company’s suitability to participate in a BCI industry credit exchange group.

Please list your top 5 competitors:*

The information supplied in this company profile will be used to assess a company’s suitability to participate in a BCI industry credit exchange group.

Does your company submit A/R electronically to any credit bureaus or reporting agencies?*

Is your company affiliated with, owned or operated by a debt collection business or commercial credit reporting agency?*

Financial Officer/Controller Name**

Financial Officer/Controller Email*

AP Contact Name:**

AP Contact Telephone:*

AP Contact Email:*

How did you learn about BCI?*

Website
Online Search
Current customer referral

Check services your company is interested in:*

Terms and Conditions

Upon receipt, your application will be reviewed. Applications accepted will be processed and an invoice will be sent to you. Once payment is received in full, your access to BCI/NACM-New England Inc. services will be activated. I understand that company fees for products and services are due upon invoice. Annual service fees for membership and groups are set at the prevailing rates, are subject to change and continue from year-to-year unless notice of cancellation in writing is given at least 30 days in advance of annual renewal date and that my company is responsible for such charges. I understand that there are no refunds, including fees for unused services. Any amount past due is subject to a monthly 1.5% finance charge. The applicant hereby agrees to pay interest or late charges on all unpaid invoices for products and services from the date due until all sums are paid in full, at the lesser of one and one half percent (1-1/2%) per month, compounded monthly, or at the highest contract rate allowed by law. All costs of collections, before and after judgment, including but not limited to court costs, interest and reasonable attorney fees.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age: because all or part of the applicant’s income devices from any public assistance program: or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission.

The applicant certifies that the statements contained in the application are accurate, that he/she will abide by the BCI/NACM-New England Inc. bylaws and regulations, and that he/she has the authority to execute this agreement on behalf of the applicant company.

I agree to the Terms & Conditions*

Yes
No

Signature / Title*

Professional Designation:

Years in Credit Profession:*

# of Credit & Collections Staff:*

Email*

Telephone Number*

Date*

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