1272 Alma Court San Jose, CA 95112-5940

____________________________________________________________________________________________________________

APPLICATION FOR CREDIT
        Salesperson:                                                  Date:
    Account Name:
Business Address:
                     City:State:Zip Code:
  Business Phone:Resale Number:
 
Business Accounts
                         Type of Business:
                         Owner/Principal:
                                            Title:
  When was business established?
  Do you require PO#’s on all Yes
                           purchases? No
 
                                 D&B Number: D&B Rating:
 
   (A)    Bank Name:
                 Address:
                Phone #:
             Account #:
 
   (B)    Please list three (3) Credit References:
            1.    Name:
                Address:
                  Phone:Fax:
                Contact:
            2.    Name:
                Address:
                  Phone:Fax:
                Contact:
            3.    Name:
                Address:
                  Phone:Fax:
                Contact:
 
Authorized Signature:_____________________________________________ Date:
Please Complete Print and Fax to (408) 494-0804
           Phone: (408) 924-0800                                                                                                                            Fax: (408) 494-0804
           Rev AAA                                                                                                                                                              0018 (ml)