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wym. <br /> YUAI6TE I1AArd"EMlEi1i'1' <br /> Credit Application <br /> SECTION 1l.- Customer Pro le l r f <br /> Company Name; ft iw Phone: ( 7 o q <br /> 3trmt nmss: 6 Fax. <br /> C}ty C —State: Lir <br /> .- <br /> Type of Business: ' Year Established: <br /> Officer or Propristror. Taxpayer <br /> if a proprietorship/individual– cial Security#: Driver's license M <br /> Nome Address: 7 Home Phone#( ) <br /> SECTION 2: Credit Request <br /> Estimated&fling for Current Se ce Request: Average Billing for Existing Service$, <br /> Aggregate Monthly Billing: <br /> SECTION 3: 811111ing Infomw 'on <br /> Preferred Payment Method: Check O EFT/ACH Draft <br /> Credit Card: 17 MasterCard 0 Visa (Acct. Exp.Date) <br /> Payment Contact Name: Payment Contact Phone#:�„ <br /> SECTION 4: Trade/Rusin References <br /> (Affiliated ownpanies cannot considered as trade references. If used, this may resuh in cartellation of credit rivi} es) <br /> t 2 — 3 <br /> Company Name 7 <br /> Address <br /> L <br /> Phone Number <br /> Fax Number <br /> SECTIONS: Bank Re mnc s <br /> Bank �- <br /> d <br /> Account fit: -- <br /> Phone:( ) Fax;( ) <br /> THE ABOVE INFORMATION 16 CC RECT TO V5 29ST OI:MY KWWLr=DGE. I AM AWARE THAT ANY AND ALL INVOICES <br /> RENDERED ARE EXPECTIEO TOB PAID WITHIN STATED TERMS AND THAT FAILURE TO COMPLY COULD RESULT IN THE <br /> CANCG LATION OF EXTENDED C EDIT PRIVILEGES. <br /> THE UNDERSIGNED AUTHORI ALL PARTIES CONTACTED TO REL"ZE CREDIT AND FINANCIAL INFORMATION <br /> REQUESTED AS PART OR CREOI INVESTIGATION. <br /> Authorized Signaturel'Title: Date:_ <br /> Sales RepmwnttMe Signature: Date: <br /> Sales manager Signature: Date; <br /> Pt. 'Q:Tti �C�� 6nH b 6b6�606i:xed HI�1 Jf]d <br />