Type of accounting applying for: Net Term _________ C.O.D. Company Check _________ other _________

Phone: __________________ Fax: __________________

Address: __________________________________________________

City: ________________________ State: ___________ Zip: ___________

Corporation _________ Proprietorship _________ Partnership _________ Other _________

State of Corporation: _________ Date Incorporated: _________ Parent Company Name _________

Owner’s Name: __________________ Home Phone#: __________________

Social Security#: __________________ Driver’s License#: __________________

TRADE REFERENCES

Name: __________________ Phone: __________________

Address: ____________________________________ City/State/Zip: __________________

Name: __________________ Phone: __________________

Address: ____________________________________ City/State/Zip: __________________

Name: __________________ Phone: __________________

Address: ____________________________________ City/State/Zip: __________________

This credit application and agreement is submitted to P.C. System in order to obtain credit.
All statements made herein are true and accurate to the best of our knowledge.

UNCONDITIONAL PERSONAL GUARANTEE

I _________ FOR AND IN CONSIDERATION OF YOUR EXTENDING CREDIT AT MY REQUEST

TO __________________ . HEREAFTER REFERRED LIABLE AND RESPONSIBLE FOR ANY AND ALL

TRANSACTION AND INDEBTEDNESS TO P.C. SYSTEMS. THE DEBT MAY BE EVENT THAT ANY

LAWSUIT IS INSTITUTED TO COLLECT ANY AMOUNT DUE. UNDER OUR ACCOUNT. I DO HEREBY

AGREE TO PAY.IN ADDITON TO THE AMOUNT OWED. ALL LEGAL FEES AND ATTORNEY’S

FEE THAT MAY BE INCURRED.

Signature: __________________ Print Name: __________________

Title: ____________________________ Date: __________________