WHITE RIVER BROADCASTING
Credit Application Form


Please correct the following errors:

Date

Business Name


Billing Address
Street
City State Zip
 
Monthly Amount of Credit Requested
   




   
Email Address
   
Telephone Number

COMPANY PROFILE
Corporation         Partnership          Limited Partnership          Proprietorship         Franchise

Date you started business or assumed control:
    Nature/Type of Business:

Officers or Principals

Name:
  Title:   Residence:    SS#

CREDIT REFERENCES: Media/Trade References:
Name Street City State Zip Phone Acct. #
             
Name Street City State Zip Phone Acct. #

BANK REFERENCES: C-Checking S-Savings M-Mortgage/Loan CPD-Charge Plate Deposits
Name Street City State Zip Phone Acct. #


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.
 
Signature of Officer or Principal Title Date
 

PERSONAL GUARANTEE
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.
 
Signature of Officer or Principal Date
   
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.