Ref No. Last: Corporation Type of Business: Business Credit Application City: Legal Form Under Which Business Operates: If Division/Subsidiay, Name of Parent Company: Name of Company Principal Responsible for Business Transactions: In Business Since: City: Name of Company Principal Responsible for Business Transactions: In Business Since: Address: General Information First: Middle: Title: Name of Business: Tax I.D.: Address: Phone: State: ZIP: Fax: Company Information Partnership Proprietorship Address: ZIP: State: Phone: Phone: Has a civil judgment been obtained against the company or any of its principals in the last ten years? [Y/N] Bank References Institution Name: Address: Checking Account : Phone: Institution Name: Address: Checking Account : Phone: Trade References Company Name: Address: Account Opened Since: Company Name: Address: Account Opened Since: Company Name: Address: Account Opened Since: Contact Name: Phone: Fax: Contact Name: Phone: Fax: Contact Name: Phone: Fax: Credit Credit Credit Title I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. I also agree to a charge on all invoices over days, and will pay all fees if action is taken for late payment. If legal action is necessary to collect sums due on this account, I agree to pay attorney fees or any collection costs and costs incurred in connection with such action; I further agree that the venue for such action be in San Bernardino, California, and that the laws of the State of California shall govern the rights, obligations and liabilities of the parties. Sign Date Has the company or any of it's principals files for bankruptcy in the last ten years? [Y/N] Please sign below using mouse or touchpad By signing your signature here it is equivalent to a written signature.