Credit Application
> 5722 Bingle Rd Ste # B
> Houston TX, 77092
> Tel: 713-337-7330
> Fax:713-337-7336
Account Executive
Business Name:
Billing Address :
Zip :
City :
Shipping Address :
Zip :
City :
Telephone No :
Fax No : Type of Business :
Years in Business : :
Are you Tax Exempt? : Yes No (If YES, please attach certificate)
Account Payable Contact :
Phone No : Fax :
Payment Terms (*Credit Card) :
Type : Month(MM) :

Year(YY) :

C.O.D. Net Term 10 Days
We Expect our monthly purchases to be : $
If Credit Card terms are accepted you will receive additional 2 % discount on your invoice. Your invoices will be charged same day.
If Credit card terms are accepte d you do not need to fill out business references.
BUSINESS REFERENCES: (Trade, Bank, Personal charge accounts & Credit Cards are NOT Acceptable)
Business Name Complete Address Telephone #
Terms of Service: I/we understand that the information furnished you on this page is for the purpose of obtaining credit from you firm. That I am/we are authorized in my/our capacity. To bind my/our firm accordingly. That all accounts or monies due shall be due 7 payable at your place of business. That all pass due accounts, notes or judgments shall bear interest paid at the rate of 1.5% per month of unpaid balances. All accounts are net 30 days a service charge of 1.5% per month (18% per annum) is added to all past due;
Print Name and Title
Authorized Signature (By Applicant)