Credit Application Form
Format: 930-555-5555
Officers or Principals
CREDIT REFERENCES: Media/Trade References
Format: 930-555-5555
Format: 930-555-5555
Format: 930-555-5555

I certify that the information provided in the application is true and correct. I hereby authorize the release of credit information requested to the above account and agree to pay by their terms (payment due upon receipt of statement/invoice). I agree that if credit is extended and any dispute arises concerning services provided or charges to Customer, any legal proceeding to resolve the dispute may be brought only in a court of competent jurisdiction located in Bartholomew County, Indiana and I consent and submit to the jurisdiction of those tribunals.


For value received, to-wit the extension of credit to the above Customer, the undersigned hereby guarantee payment of all sums due to the Obligee, now owing or hereafter incurred by the Customer, including interest, costs, expenses and reasonable attorney fees. This guarantee is absolute and unconditional. Demand and notice of nonpayment or nonperformance, diligence in collection and notice of acceptance of this guarantee, are hereby expressly waived. This Personal Guarantee shall remain in full force and effect despite and change in the form of ownership of the business unless White River Broadcasting is notified in writing of any such change.

The White River Broadcasting Company and Radio Stations WCSI/WKKG/WINN/WWWY do not discriminate in any way on the basis of race, gender or ethnicity with regard to its advertising practices.