Application Form

To become a member of Printing Industry Credit Executives
1. Fax:	Complete the form, print it, and fax to 716-878-0479*
2. Mail:	Complete the form, print it, and mail to: 1100 Main Street, Buffalo NY 14209

Please enroll the following company as a member of PICE with all the rights and privileges thereof:
Company
Address
City	State/Province Mail Code

Primary Contact
Title
Phone	Fax
Email

Secondary
Title
Phone	Fax
Email

Main Type of Business - Printers

(check all that apply)	Books Catalogs Direct Mail Inserts General

	Other

Main Type of Business - Non-Printers

(check all that apply)	Paper Pre-press Bind/finish Other

Fees
Annual dues		$900.00
One time fee*		$225.00	*PICE Credit Exchange access/setup fee
Total		$1,125.00

We agree to cooperate with Printing Industry Credit Executives, Inc. in furthering its objectives, abide by its bylaws, and observe the stated legal guidelines for participation.

Signed	_________________________ Date _________________________

Printed Name	_________________________ Title _________________________