Updated Credit Application New Credit Application

BILLING ADDRESS

Company Name:
DBA (If different from above):
Contact:
Address:
City: State: ZipCode:
Telephone: Fax :
E-Mail:

SHIPPING ADDRESS

Name:
Address:
City: State: ZipCode:
Telephone: Fax:
E-Mail:
Request $ Credit Line

Type of Account Applying For: Net Terms C.O.D. Company Check
Have you ever applied for credit with Computer Station Corporation before? YES NO

LEGAL ENTITY: Complete Applicable Section Below

 Length of time in business: How long in present location?:

OFFICERS:
President:
Vice-President:
Treasurer:
Controller:
Accounts Payable Contact:

PRINCIPAL OWNER / OFFICER:
Home Address:
City: State: ZipCode:
Social Security Number: Home Phone:
Driver's License Number:

From where is your business operated? HOME COMMERCIAL BUILDING
Do you own or rent your business property? OWN RENT
Name of landlord or mortgage holder:

ORGANIZATIONAL INFORMATION

Sole Proprietor Partnership
Corporation (State): Incorporation Date:
Other:

ANNUAL SALES VOLUME

Less than $100K $101 - $250K $251- $500K $1000K and Over
Number of Employees: Average Account Payable Aging:
Are Purchase Orders Used? YES NO
Rating in Dun & Bradstreet? YES NO Rating:
D-U-N-S®:

BANK INFORMATION

A. Bank:
Checking Account #: Date Account Open:
Loan #:
Saving Account #: Date Account Open:
Address:
City: State: ZipCode:
Contact Person:
Phone: Fax:

B. Bank:
Checking Account #: Date Account Open:
Loan #:
Saving Account #: Date Account Open:
Address:
City: State: ZipCode:
Contact Person:
Phone: Fax:

TRADE CREDIT REFERENCES

1. Name:
Type of Business: Account #:
Address:
City: State: ZipCode:
Phone: Fax:
Payment Terms: Contact:

2. Name:
Type of Business: Account #:
Address:
City: State: ZipCode:
Phone: Fax:
Payment Terms: Contact:

3. Name:
Type of Business: Account #:
Address:
City: State: ZipCode:
Phone: Fax:
Payment Terms: Contact:

4. Name:
Type of Business: Account #:
Address:
City: State: ZipCode:
Phone: Fax:
Payment Terms: Contact:

AGREEMENT TO TERMS

In Signing below, I certify to Computer Station Corporation [sometimes called "you" or "CSC"] that:

1. CREDIT AGREEMENT: Everything in this Agreement is true and complete, and I am authorized to fill out this Agreement and sign below for the Company shown above. I understand that you may investigate my financial status and the Company's financial status further, and request other documents or references from us. If we do not comply, or if anything turns out to be untrue, it is grounds for all credit to end immediately, and all account balances to become immediately due and payable.
2. SECURITY INTEREST: We hereby agree to pay by the terms of sale listed on each Computer Station Corporation invoice. In case of a credit sale, you reserve the right to charge a finance fee of one and one-half percent per each thirty-day period, or part thereof, for any invoice that is past due. In order to induce Computer Station to extend credit for the purchase of CSC's products and for other good and valuable consideration, we hereby convey, grant and transfer to CSC a purchase money security interest in the Products and all proceeds therefrom until we perform all of our obligations hereunder. We further agree to pay all collection fees, reasonable attorney fees, court costs and other expenses incurred by Computer Station Corporation.
3. RETURNED CHECKS: I understand that if the Company's check is returned by the bank, we will be accessed $35.00 for each check returned.

I understand that these terms are accepted by the Company by my submitting the Credit Application to Computer Station Corporation.

Printed Name:
Signature of Applicant:
Title of Applicant:
Date: Time: