Name of Organization __________________________________________________________ Type of Organization ___________________________________________________________ Years in Existence _____________________________________________________________ Billing address ________________________________________________________________ City/state/zip _________________________________________________________________ Shipping address _______________________________________________________________ City/state/zip _________________________________________________________________ Telephone number _______________________________________________________________ FAX number _____________________________________________________________________ Email address __________________________________________________________________ Web page _______________________________________________________________________ Type of entity: ____Corporation ____Partnership/Proprietorship ____Nonprofit/School Name of owners, officers or directors _________________________________________ Business Bank Account References Bank name/branch________________________________________________________________ Street__________________________________________________________________________ City/State/Zip__________________________________________________________________ Checking account number_________________________________________________________ Name of contact_________________________________________________________________ Trade Account References Please provide information for 3 vendors with whom you have established credit: Company_________________________________________________________________________ Address_________________________________________________________________________ City/State/zip__________________________________________________________________ Phone #_________________________________________________________________________ Name of contact_________________________________________________________________ Account #_______________________________________________________________________ Company_________________________________________________________________________ Address_________________________________________________________________________ City/State/zip__________________________________________________________________ Phone #_________________________________________________________________________ Name of contact_________________________________________________________________ Account #_______________________________________________________________________ Company_________________________________________________________________________ Address_________________________________________________________________________ City/State/zip__________________________________________________________________ Phone #_________________________________________________________________________ Name of contact_________________________________________________________________ Account #_______________________________________________________________________ Company hereby agrees to pay invoices within 30 days of receipt. Past due accounts are subject to a 1% per month interest charge. Signed_____________________________ Title________________________ Company___________________________ Date________________________ Return fax completed credit application to 408 353-4675.