Bingham Enterprises Account - Credit Application - Terms: 2%10 days/Net 30 days

Name _____________________________________________________________________

Address___________________________________________________________________

City, State, Zip______________________________________________________________

Years at address__________ Years in business__________

Phone #________________________________Fax #________________________________

E-Mail Address:________________________________

The following information must be completed in full, and will be held in the strictest confidence:

Bank_____________________________________Branch__________________________________

Phone____________________________________Acct. No.________________________________

Bank_____________________________________Branch__________________________________

Phone____________________________________Acct. No.________________________________

Trade References:

   Name                                                Address                                                     Phone and Fax Nos.

1._____________________________________________________________________________________

2._____________________________________________________________________________________

3._____________________________________________________________________________________

In making this application, I understand that Bingham Enterprises will reserve the right to pull a credit file at any time to determine my buiness and personal worthiness, credit capacity, and credit standing.  I certify that all information on this form is correct, and I fully understand the credit terms and agree to the proper payment in consideration of extended credit.

The above information is for the purpose of obtaining credit and is warranted to be true.  I/We authorize the person or firm to whom this application is made, to investigate the references listed pertaining to my/our credit responsibility.  I agree to the above terms of sale to your company.

What is the high line of credit desired?_____________________________________________________________

Application signature attests financial responsibility, ability, and willingness to pay our invoices in accordance with the terms stated above.

Signature:_________________________________________________Title:_____________________________             

Print Full Name_______________________________________________________Date:___________________

This section for Bingham Enterprises use only:

Customer Type:__________________________________________________Credit Limit:_______________________

Authorized by:________________________________________________________Date:_______________________