17238 South Main Street
Gardena, CA 90248
Phone:310-719-2520
Fax: 310-719-2303

CREDIT APPLICATION
Company: Phone: Fax:
Address: Street: City: State: Zip:
List Name(s) and Title(s) of Corporate Officers, Partners or Owners:
Name: Title:
Name: Title:
Type of Business: Corporation Partnership Proprietorship Trust Other:
Annual Dollar Volume (Sales): Accts. Payable Contact:
Year Established: Number of Employees: How long at present Location:
Location: Owned Leased Monthly Rental Other:
Bank: Acct #: Checking Savings Loan
Branch Address: Street: City: State: Zip:
Phone: Fax:
Officer familiar with acct(s): Title:
Trade References:
(1) Name: Phone: Fax:
Address: Street: City: State: Zip:
(2) Name: Phone: Fax:
Address: Street: City: State: Zip:
(3) Name: Phone: Fax:
Address: Street: City: State: Zip:
I authorize our bank(s) to furnish financial information required by The Company in connection with this application for credit.

I/We certify that the above statements are true, and authorize The Company to investigate the information above for the purposes of obtaining merchandise on credit. In consideration of personal benefits accruing to me I guarantee payment of all correct charges to the business and if for any reason the account is not paid when due I will pay it and if collections is required, pay a reasonable attorney fee, collection fee, and any other reasonable cost incurred in the collection of said account.
I have read and agree to the terms above [ Yes:  No: ]
Name: Date: