CREDIT APPLICATION

Phone______________ Fax_________________ Cell______________________
Owner/Manager_______________________________Tel.No.______________
How long in business________________________D & B Rated__________
Trade References:
Name_______________________________Address_____________________________________

Phone_______________________________Fax____________________________
Name_______________________________Address_____________________________________

Phone_______________________________Fax _______________________
Bank References:
Name_______________________________Address____________________________________________
Name_______________________________Address____________________________________________
Credit line requested $_________________________________

Pending lawsuits against Company:________________________________
***The undersigned authorizes inquiry as to credit information. We further acknowledge

that credit privileges, if granted, may be withdrawn at any time. All Statement made herein are true and accurate to the best of our knowledge. We authorize the above company to make any and all inquiries necessary for action of this credit application. We hereby indemnify the above company and its agents, from any liability resulting from their credit survey.***

Authorized

Signiture X_______________________________ Title_________________________________

Please list the persons authorized to charge on your account

__________________________________________________________________________________

Do you want this strictly enforced?____________

Terms desired: Net 30_____ C.O.D._____ Cash Only______ Credit Card____

Payment personally guaranteed? X______________________ Title:__________