Customer Credit Application Form

Product Information


Company Name& Address					Application Date:
*Legal Business Name			*Date Established		*Phone Number
DBA
*Billing Address
*City		*State			*Zip
Names of Principals of Firm
*President		*CFO/Treasurer			*Email Address
*Vice-President		*Controller
Corporation General Partnership Subsidiary Of:
Sole Proprietorship Limited Partnership Division Of:
Type of Business		Number Of Employees			Accounts Payable Contact
Parent Company		Name/Title of Person Executing Guaranty on Behalf Of Parent Co.
Address
City		State			Zip
Credit Information
Credit Line Desired Per Month Based on Projected Volume				Sales Representative
Do You Use Purchase Orders?		Yes No		Buyer's Phone/FAX
Is Merchandise for Resale?		Yes No		Buyer Name
Authorization
	FINANCIAL STATEMENTS: Customer's most recent financial statements are required to be delivered with this credit application and shall be kept confidential.

	By Clicking "I Accept" below, I, (Full Name), (Title), dated* hereby certify that all of the information on this Credit Application is correct and agree to the following terms and conditions:

	TERMS: Net 30 days. This agreement supercedes all contrary or inconsistent provisions in customer's current or future purchase order(s), or any other business form, and no modification of this agreement shall be binding unless executed in writing by a duly authorized representative of each party to this agreement. If the account(s) created by this agreement is forwarded to an attorney or collection agency, customer agrees to pay all costs incident thereto, including reasonable attorney's fees. Should the account(s) created by this agreement become delinquent, Company shall have the right to refuse shipment of products to customer. This is the entire agreement. This agreement shall be governed by and construed in accordance with the laws of the State of California, excluding its body of law controlling conflicts of law. Venue for any action hereunder shall be in Santa Clara County, California.