Credit Application

Last Name:

First Name:

Middle Initial:

Title:

Name of Business:

Tax I.D. Number:

Address:

City:

State:

Zip:

Phone:

Type of Business:

In Business Since:

Legal Form Under Which Business Operates: Corporation Partnership Proprietorship

If Division/Subsidiary, Name of Parent Company:

In Business Since:

Name of Company Principal Responsible for Business Transactions:

Name of Company Principal Responsible for Business Transactions:

Institution Name:

Contact Name:

Checking Account #

D&B Account #

D&B Rating:

Address:

Phone:

FAX:

Company Name:

Company Name:

Company Name:

Contact Name:

Contact Name:

Contact Name:

Address:

Address:

Address:

Phone:

Phone:

Phone:

Fax:

Fax:

Fax:

Account Opened Since:

Account Opened Since:

Account Opened Since:

I hereby certify the information contained herein is complete and accurate. This information has been furnished with the understanding it will be used to determine the amount and the Multi-Panels, Inc `terms & conditions` (attached & initialed) of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to Multi-Panels, Inc., order to verify the information contained herein. Credit Application must be signed by an Officer of the Company