Credit application

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PLEASE PRINT OUT THIS FORM AND SEND IT TO US AT:
17304 PRESTON RD. SUITE 601  DALLAS, TX 75252 
OR FAX IT: (972) 407 1616


BUSINESS INFORMATION:

Name of Business:        Phone:

Street Address:              City:    State:   Zip:

Billing Address:             City:     State:   Zip:

Year Business Established:     Number of Employees:     Amount of Credit Requested:

Type of Business: (select one)     Other: (explain)


COMPANY PRINCIPALS RESPONSIBLE FOR BUSINESS TRANSACTIONS:

Name:     Title:     Address:       Phone:

Name:     Title:     Address:       Phone:

Key Employee Names:     Purchaser:    Bookkeeper: 


BANK REFERENCE:

Bank:     Address:     Phone:

Account #:     Checking:   Savings:    Loan:

Person Signing Checks:     Drivers License #:  SS #:    State:


TRADE REFERENCES:

Company:     Address:     Phone #:

Company:     Address:     Phone #:

Company:     Address:     Phone #:

Company:     Address:     Phone #:

 

CONFIRMATION OF INFORMATION ACCURACY & PERSONAL GUARANTY:
In consideration of credit extension I / We personally guarantee full and prompt payment according to the terms of all invoices rendered. All past due accounts shall be subject to interest at the maximum rate allowed by law until paid. If my / our account is placed in the hands of an attorney for collection or if collection is made through bankruptcy or probate proceedings, I /We agree to pay a reasonable amount in attorney's fees on both the principal and interests charged. Any account with prior NSF checks are subject to shipments on a prepaid basis. I / We verify that all information supplied is true and correct.

SIGNATURE:     TITLE:     DATE:


FOR OFFICE USE ONLY

Date opened:     Account #:     Credit Line: Terms:

JBT Rating:     Approved By:     Comments: