CREDIT APPLICATION & ACCOUNT AGREEMENT (Commercial Account)Credit Application & Account Agreement • March 27th, 2013 • Texas
Contract Type FiledMarch 27th, 2013 JurisdictionCompany’s Full Legal Name Phone: Fax: Street Address (required) City: State & Zip: Mailing Address (if different) City: State & Zip: Contact Person for Billing Matters: Title: Phone / Fax / Email: Years in Business: Purchase Order Required Yes No Type of Business Website URL: COMPLETE APPROPRIATE SECTIONS REGARDING BUSINESS STRUCTURE SOLE PROPRIETORSHIP / OWNERSHIP Name Birth Date Soc Sec # Driver’s License / State / #: Residence Address Years at Address Nearest Relative / Name & Relationship Phone: Address: Work Address Years at Address Prior Work Address Prior Business Names Spouses Name Birth Date Social Security # Driver’s License / State / #: COMPANY / BUSINESS ENTITY Business Structure: Q Corporation Q Limited Liability Company Q Partnership (check one) Q General Q Limited Q L.L.P. (Attach Copy of Formation Documents – Certificate of Formation, Partnership Agreement, Etc.) Officers, Members and/or Partners: Name: Address: Title Birth Date Soc Sec 1. 2. 3.