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9400 Southpark Center Loop, Orlando, FL 32819

APPLICATION FOR CREDIT

INTERNATIONAL
Email: creditdepartment@hmhco.com

Corporation Partnership Proprietorship LLC

Legal Name:

Trade Styles (DBA, Trading As, etc.):

Name of Parent Company (If Division or Subsidiary):

Address:

City: State: Zip Code:

Corporate Phone #: Website:

NAMES OF PRINCIPAL OFFICERS, PARTNERS, OWNERS:

Name: Title:

Name: Title:

Name: Title:

Accounts Payable Contact: Phone:

Fax: Email:

HAS HOUGHTON MIFFLIN HARCOURT EVER SOLD TO YOU BEFORE OR TO ANY PRESENT OR FORMER AFFILIATE?
YES NO

If yes, Under What Name and When:

YEARS IN BUSINESS:

APRIL 2018
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TRADE REFERENCES:
(Please include complete addresses)
1. Name: Phone:
Address: Fax:
Acct #:

2. Name: Phone:
Address: Fax:
Acct #:

3. Name: Phone:
Address: Fax:
Acct #:

* Estimated Value of Annual Order(s) USD:

* If order(s) exceed USD100,000 a copy of the latest financial statements must be submitted with this application.

ADDITIONAL INFORMATION MAY BE REQUIRED AS NEEDED

The information in this application and in all financial statements submitted in connection herewith is for the purpose of
obtaining credit and is represented by the applicant to be true and complete. The applicant authorizes Houghton Mifflin
Harcourt to investigate all credit references and any other matters pertaining to its financial responsibility. The undersigned
authorizes its bank(s) and creditors to submit complete information for the purpose of credit evaluation.

Date:

Signed By:

Print Name:

Title:

APRIL 2018