Credit Application

Personal Systems Plus, Inc. 30432 Euclid Ave. Phn (440) 585-7013 Wickliffe, OH 44092 Fax (440) 585-2808 Email: pspi@clevelandnet.com
Credit Application (fax to above)
Company Name Billing Contact Billing Address City, State Zip Referred By Names & Titles of Authorized Purchasers Are Purchases Tax Exempt?	________________________________ Area & Phone ____________________ ________________________________ Other Phone ____________________ ________________________________ Fax Number ____________________ ________________________________ Email Address ____________________ ________________________________ D & B Number ____________________ ________________________________ Are P.O.'s ____________________ Required? ________________________________ If yes, Exemption _________ Reason: ______________ Number: ____________________ (attach exemption form)
Company Type Office-Owner Names & Titles (if other than above) Business Product / Service	Corporation Partnership Sole-Proprietorship ________________________________ Year Started __________ ________________________________ Annual Sales __________ ________________________________ # of Employees __________ ______________________________________________
Checking Acct Bank Name Account Number	Branch - ____________________________________ Location ________________________ ____________________ Contact ________________ Phone __________________
Credit References Account Years Company Name Contact Number Associated Phone 1) _________________________ ________________ ______________ ______ ________________ 2) _________________________ ________________ ______________ ______ ________________ 3) _________________________ ________________ ______________ ______ ________________
____________________________________ __________________ ____________ Customer Authorized Signature Title Date