2901 Moorpark Avenue, ste. 100, San Jose, CA 95128
          Tel: (408) 248-8811  Fax: (408) 551-6882
Email: sales@applied-computer.com
 http://www.applied-computer.com	

CONFIDENTAL BUSINESS CREDIT APPLICATION

BILLING ADDRESS:	                                     SHIP-TO ADDRESS:
Company _______________________________	         Name________________________________________

DBA/Trade Style_________________________	         Street________________________________________

Street/PO Box ___________________________	         City/State/Zip _________________________________

City/State/Zip ___________________________          Telephone____________________________________

Telephone ______________________________

Fax ____________________________________

Contact__________________________  Email Address___________________________________________

Requesting $______________Credit Line     	Type of Account Applying For: ___Net Terms ___ C.O.D. ___Credit Card

For terms accounts, Applied Computer Online Services 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_____________  Treasurer____________
Parent Company_________________________         Street ____________________ City/State ___________ 
Fiscal Year End _________________________         State of Incorporation ___________________________

If less than one (1) year in business please provides the following:
Social Security # ________________________	         Principal Name_________________________________
Home Address  _________________________         Telephone _____________________________________
City __________________________________         State ____________________  Zip _________________

PARTNERSHIP 
Date Started ____________________________	         How long at present location ______________________
Partner ________________________________     	     Partner _______________________________________
Home Address __________________________         Home Address__________________________________
Telephone _____________________________	          Telephone _____________________________________
Fiscal Year End _________________________          Other Holdings _________________________________
Social Security # ________________________	          Social Security #  _______________________________
Telephone _____________________________	           Drivers License # _______________________________

PROPRIETORSHIP
Date Started  ___________________________	         How long at present location _______________________
Proprietor  _____________________________         Fiscal Year End _________________________________
Home Address  _________________________	         Other Holdings __________________________________
______________________________________	         Social Security #  ________________________________
Telephone _____________________________	         Drivers License # ________________________________
TYPE OF BUSINESS
Sales Tax Status _______________________	         Tax Exempt Permit # _____________________________
Please attach exemption certificate.

Federal Tax ID: ________________________        D-U-N-S# ______________________________________

BANK INFORMATION
Bank Name ________________________________________ Phone ________________________________
Contact Name ______________________________________ Fax __________________________________
Address _________________________________________________________________________________
Checking/Savings Acct#1 ___________________  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 ______________________________  Fax _________________ Contact _____________________

PLEASE ATTACH YOUR MOST RECENT FINANCIAL STATEMENT TO ACCOMPANY THIS APPLICATION. This is our authorization to APPLIED COMPUTER ONLINE SERVICES 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 ONLINE SERVICES invoices. Should those terms now or at any future date include a service charge for late payment or collection and attorney fees in the event of legal actions, we agree to pay charges. Buyer consents to the in person are 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.

I, _______________________________________, personally guarantee all payments to APPLIED COMPUTER ONLINE SERVICES.

Signed __________________________________       Title ______________________  Date __________________
 
Signed __________________________________       ] Principal \Guarantor \Other (specify)  _______________

(Please complete, print, and fax at 1-408-551-6882)
rev 11/12