Credit Application And Agreement For Credit Sales - Ced

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CREDIT APPLICATION

AND AGREEMENT FOR

CREDIT SALES

CONSOLIDATED ELECTRICAL DISTRIBUTORS, INC.

MAIL THIS APPLICATION TO:

To CONSOLIDATED ELECTRICAL DISTRIBUTORS, INC.: For the purpose

CED - Bakersfield

of procuring and establishing credit, from time to time, the undersigned Applicant

301 Espee Street, Ste A

furnishes the following information, including the attached Financial Statement.

Bakersfield, CA 93301

Applicant represents and warrants said information is true and correct and a

true and complete statement of its financial condition.

APPLICANT: BUSINESS OR CORPORATE NAME

APPLICATION DATE

BUSINESS STREET ADDRESS

BILLING ADDRESS: STREET OR P.O. BOX

CITY

STATE

ZIP

CITY

STATE

ZIP

BUSINESS TELEPHONE NO.

FAX NO.

E-MAIL

YEAR BUSINESS

NO. OF EMPLOYEES

WAS ESTABLISHED

WE ARE ENGAGED IN THE BUSINESS OF:

MONTHLY STATEMENT

YES

SOLE PROPRIETOR

CORPORATION

OF ACCOUNT REQUIRED?

PARTNERSHIP

LLC

CONTRACTOR’S LICENSE NO.

STATE ISSUED

A/P CONTACT NAME

BUSINESS BUILDING IS

FAX # / EMAIL

OWNED

RENTED

OWNERS (IF APPLICANT IS A SOLE PROPRIETOR OR PARTNERSHIP)

OFFICERS (IF A CORPORATION)

NAME

TITLE

HOME ADDRESS

HOME PHONE NO.

NAME

TITLE

HOME ADDRESS

HOME PHONE NO.

NAME

TITLE

HOME ADDRESS

HOME PHONE NO.

BANK OR SAVINGS AND LOAN ASSOCIATION:

NAME

BRANCH ADDRESS

ACCOUNT NO.

TYPE OF ACCOUNT

10.

NAME

BRANCH ADDRESS

ACCOUNT NO.

TYPE OF ACCOUNT

11.

APPLICANT’S PRINCIPAL CREDIT REFERENCES (LIST AT LEAST THREE)

NAME

ADDRESS, CITY, STATE & ZIP

PHONE NUMBER

AMOUNT OWING

12.

NAME

ADDRESS, CITY, STATE & ZIP

PHONE NUMBER

AMOUNT OWING

13.

NAME

ADDRESS, CITY, STATE & ZIP

PHONE NUMBER

AMOUNT OWING

14.

NAME

ADDRESS, CITY, STATE & ZIP

PHONE NUMBER

AMOUNT OWING

15.

16. Has Applicant or any of its Owners, Principals, Partners, Officers, or Directors ever filed a voluntary petition in bankruptcy, been adjudged bankrupt, or made an assignment for the

benefit of creditors?

WRITE ANSWERS YES OR NO

17. Are taxes owed by Applicant to any taxing authority

Has a tax lien or civil suit been filed against Applicant or any of its Owners, Principals, Partners, Officers, or Directors

past due?

within the past six years?

18. Is Applicant or any of its Owners, Principals, Partners, Officers, or Directors, a guarantor or endorser of debts or notes owed by others?

19. Does Applicant now have a merchandise order pending with CONSOLIDATED

If yes, what is the approximate amount of the order?

ELECTRICAL DISTRIBUTORS, INC.?

APPLICANT:

1) Please complete and sign the reverse side of this form, 2) Please attach a current financial statement,