2901 Moorpark Avenue, Suite 100, San Jose, CA 95128 Phone: (408) 248-8811 Fax: (408) 551-6882 http://www.applied-computer.com
CONFIDENTIAL BUSINESS CREDIT APPLICATION
(Please complete, print, and fax to us at 1-408-551-6882)
Account #:		Date: / /
BILLING ADDRESS:		SHIP ADDRESS:
	Company Name  DBA/Trade Style  Street/PO Box Telephone  Contact		Name Street City/State/Zip Telephone
Requesting($)	Credit Line	Type of Account Applying For:   Net Terms C.O.D. Credit Card
For terms accounts, Applied Computer will charge interest equal to the lesser of 1.5% per month or the highest rate allowed by law on any amount paid past due.
LEGAL ENTITY COMPLETE APPLICABLE SECTION BELOW
CORPORATION Date Started How Long at present location President Vice President Treasure Parent Company City State Fiscal Year End State of Incorporation If less than one ( I ) year in business please provide the following: Social Security #                        Principal Name Home Address Telephone City State Zip
PARTNERSHIP Date Started    Partner (A)      Home Address                      Telephone       Fiscal Year End Social Security # Drivers License # How long at present location Partner (B)     Home Address                       Telephone       Other Holdings   Social Security #   Drivers License #
PROPRIETORSHIP
Date Started    Proprietor          Home Address                           Telephone        How long at present location Fiscal Year End   Other Holdings   Social Security #   Drivers License #
TYPE OF BUSINESS
Sales Tax Status Tax Exempt Permit # Please attach exemption certificate. Rated in Dun & Bradstreet? Yes No Rating: D-U-N-S#
BANK INFORMATION
Bank Name Phone Fax  Contact  Address City State Zip Checking/Savings Acct# I. Checking/Savings Acct# 2. Loan# Lines of Credit
TRADE CREDIT REFERENCES (Open Accounts Only)
1 ) Company Name Acct. # Address City State Zip Telephone Fax Contact 2 ) Company Name Acct. # Address City State Zip Telephone Fax Contact 3 ) Company Name Acct. # Address City State Zip Telephone Fax Contact
LESSOR/OWNER
Name Own Lease Rent Address City State Zip Telephone Contact

PLEASE ATTACH YOUR MOST RECENT FINANCIAL STATEMENT TO ACCOMPANY THIS APPLICATION. This is our authorization to APPLIED COMPUTER to contact the references provided so that information may be obtained to consider granting credit privileges to us . We believe our company is financially able to meet any commitments we have made and we intend to pay promptly in accordance with the payment terms indicated on APPLIED COMPUTER invoices. Should those terms now or at any future date include a service charge for late payment or collection and attorneys in the event of legal action, we agree to pay such charges. Buyer consents to the in person am jurisdiction of any state or federal court located in San Jose. Buyer agrees that services of process may be made by mailing a copy of the summons and complaint to Buyer at its address set for in Sellers records. In addition, my signature below signifies my approval for my Bank and Creditors to respond to any credit inquiries regarding this application.

Signed_______________________________       Title       Date 

Signed_______________________________       Principal   Guarantor   Other (specify)__________

(Please complete, print, and fax to us at 1-408-551-6882)

rev 7/13