TODAY'S COMPUTERS APPLICATION FOR CREDIT was not designed to be completed on your computer.) COMPANY LEGAL NAME & DBA, IF APPLICABLE_____________________________________________________________________ PROPRIETORSHIP______ PARTNERSHIP______ CORPORATION_______(state & year of incorporation)___________________ CONTACTS: PRESIDENT________________________CFO_________________________A/P_____________________________ DO YOU USE PURCHASE ORDERS?__________AUTHORIZED PURCHASERS___________________________________ DUN & BRADSTREET NO.____________________CREDIT LINE/TERMS YOU ARE REQUESTING_____________________________ STATEMENT OF OWNERSHIP (for other than publicly-held companies) NAME OF LARGEST SHAREHOLDER_______________________________________SOC. SEC. NO.__________________________ ADDRESS_____________________________________CITY_________________________________STATE___________ZIP________ HOME PHONE____________________________PERCENTAGE OWNERSHIP_______________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- NAME OF LARGEST SHAREHOLDER_______________________________________SOC. SEC. NO.___________________________ ADDRESS_____________________________________CITY_________________________________STATE___________ZIP_______ HOME PHONE____________________________PERCENTAGE OWNERSHIP_______________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- BANKING INFORMATION BANK__________________________PHONE________________CONTACT_____________________________ACCT. NO._________ BANK__________________________PHONE________________CONTACT_____________________________ACCT. NO._________ TRADE REFERENCES NAME__________________________PHONE________________CONTACT_____________________________ACCT.NO._________ NAME__________________________PHONE________________CONTACT_____________________________ACCT.NO._________ NAME__________________________PHONE________________CONTACT_____________________________ACCT.NO._________ CERTIFICATION AND AUTHORIZATION The person signing below certifies that all information on this application is correct and understands that this information will be used by Today's Computers to determine the credit worthiness ot the applicant. The signature below is authorization by the applicant to the banks and trade references listed on this application to release information about the applicant. Authorized Signature_____________________________Printed Name/Title________________________________Date________ |
 |
 |
 |
 |
 |
 |
 |
 |
 |