Business Credit Application

Full Name of Firm ___________________________________
Address ________________________________________City_____________ State/Zip ___________
Phone__________________ Fax _________________ E- Mail ________________
Sole Proprietorship __ Partnership __ Corporation __Other (Specify) ____________
Date Incorporated or Established ________ Resale # ______________Contractors # _____________
Federal Tax I.D. # _________________

OWNERSHIP INFORMATION (Name of two principals or Officers if not Sole Proprietorship)
1. Name- __________________________ Title__________________________
Social Security # ________________ Date of Birth ______ Drivers License _____________________
Residence Address ___________________________City_____________ State/Zip _______________
2. Name __________________________ Title ____________________
Social Security # _________________ Date of Birth ______ Drivers License ____________________
Residence Address ___________________________City _____________ State/Zip _______________

TRADE REFERENCES
1. Company Name _____________________________ Account # __________ Phone/Fax__________
Address ______________________________City _______________________ State/Zip ___________
2. Company Name _____________________________ Account # __________ Phone/Fax __________
Address _________________________ City ___________________________ State/ Zip ___________
3. Company Name ___________________________ Account # ____________ Phone/Fax __________
Address __________________________ City __________________________ State/Zip ___________

BANK ACCOUNT INFORMATION
Name of Bank ______________________________________________ Branch ____________________
Address _________________________________ City ______________________ State/Zip _________
Checking Acct. # _________________________ Savings Acct. # ________________________

AUTHORIZED SIGNERS _________________________________________________________________
Do you use purchase orders? __________ Job Names? ________

By signing I (we) ask that an account be opened for myself/company.
In the event an account is opened for myself/company, I (we) agree to the following terms and conditions:

1. INVOICE TERMS: Net 30 Days.
2. LATE CHARGES: 1.5% per month or maximum allowable rate. Minimum of $.50 per month.
3. ACCELERATION CLAUSE: In the event the account becomes delinquent, creditor reserves the right to accelerate and demand payment of the balance in full, together with all accrued interest, late charges and costs of collection.
4. PERSONAL GUARANTEE: In the event of default, the undersigned officer(s) agree to be jointly and severally liable for all amounts due therein.
5. COLLECTION FEES: In the event of default, I (we) agree to pay all reasonable attorney's fees and costs incurred by creditor to collect all amounts due.
6. AUTHORIZED BUYERS: I (we) agree to be responsible for all purchases made to this account by the authorized buyers above named and subsequently authorized by us unless I (we) have notified you/creditor in writing, that said parties are no longer authorized to charge to said account.
7. AUTHORIZATION TO CHECK CREDIT HISTORY: When making application, it is understood that an investigation of my references and credit history will be conducted, including information from credit reporting agencies.

TITLE_____________________ DATE _________ SIGNATURE __________________________
(Authorized Officer Only)