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Company Name:  

Address:

City:   State/Province:   Zip: 

Phone No:   Fax No:    Alternate No:

D&B No:   How long at this address?   

Date Business Started:   Type of Ownership: Select One Individual Partnership Corporation

Name(s) of Owners/Officers: 

Name of Business Bank:   Branch: 

Checking Account No:    Approx. Inventory Value:  

Approx. Equipment Value: 

Line of Credit Requested:

OPEN ACCOUNT CREDIT TERMS ARE NET 30 DAYS FROM INVOICE DATE. A SERVICE CHARGE OF 1.5% PER MONTH WILL BE CHARGED ON PAST DUE ACCOUNTS. ALL LEGAL EXPENSES INCURRED DURING COLLECTION OF PAST DUE ACCOUNTS WILL BE PAID BY THE APPLICANT.

By my signature, I acknowledge I have read and agree to comply with the credit terms listed above.

**THIS APPLICATION WILL NOT BE PROCESSED WITHOUT A VALID SIGNATURE**

        Owner of Principal Officer (Printed Name)___________________________

        Owner or Principal Officer (Signature)_______________________________

On consideration of sales to the to the above open account, I personally guarantee payment for all materials purchased, and any service charges and attorney's fees incurred on overdue accounts by the above applicant.

        Guarantor's Signature____________________________________

        Printed Name__________________________________________

Fax Credit Application, Business References, & Tax ID Form to (313) 843-8948