Account Application | Competition Specialties, Inc

INTER-COMPANY USE ONLY
Sales Mgr App ________	Cust # ________
Credit Terms ________	Territory ________
Delivery ________	Cust Type ________
Approved By ________	Credit Limit $________

Please select your desired account type:

Cash	Credit Card
Open Account	Company Check / COD

Account Type Desired	Requested Credit Limit $
Company Name	Phone/Fax
DBA, if different from above
Billing Address	City, State, Zip
Shipping Address, if different	City, State, Zip
Email
Business Location Commercial Building Internet-Based Home Residence	Is this a Corporation? Yes No
Years at this Location Years in Business	IRS ID Number Resale Number *NOTE: Businesses in California must fill out the California Resale Certificate form and submit separately.
In the Business of	Owner/Partner/Officer SSN
Previous Addresses	Other Location Addresses
Name of Manager	Name of Buyer
Name and Title of Owners/Partners/Officers
Bank information must be complete for consideration of open terms.
Bank Name	Account Number
Bank Address	City, State, Zip
Bank Phone/Fax	Do you pledge to borrow on your accounts receivable? Yes No

Business References: Must be complete for consideration of open terms and company check!

Name Address	Phone/Fax City, State, Zip
Name Address	Phone/Fax City, State, Zip
Name Address	Phone/Fax City, State, Zip
Name Address	Phone/Fax City, State, Zip

I/we authorize CSI to investigate bank/business references listed for the purpose of obtaining an account with CSI and certify the information given to be current and correct. Upon submitting this application, I/we personally guarantee payment of all invoices in full and in accordance with the terms of sale set forth by Competition Specialties, Inc. (CSI). Copies of CSI terms and policies are available upon request, or online at http://www.compspecialties.com/terms. I/we fully understand this to be a binding obligation, which in the event the CSI brings legal action to enforce payment, I/we promise to pay past due service charges/collection agency charges/attorney fees and court costs.

Owner/Partner/Officer Name*

I certify I am the Owner, Partner, or Officer of my business, and agree to the above statement.