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Credit application

CREDIT APPLICATION

(xxx) xxx-xxxx
(xxx) xxx-xxxx

Type of Organization*:

Name and Title of Person Requesting Credit*:
Billing/AP Contact Name*
Telephone Number*(xxx) xxx-xxxx
E-mail for Invoices*:
Material Purchased For*:
Resale Certificate #*:

List Name of Principal Corporate Office

(xxx) xxx-xxxx

If there are additional owners please enter their full name, full address and phone numbers in the field below:

BANK REFERENCE:

(xxx) xxx-xxxx

TRADE REFERENCES:

Please list references (USA references preferred):

Reference #1

(xxx) xxx-xxxx
(xxx) xxx-xxxx

Reference #2

(xxx) xxx-xxxx
(xxx) xxx-xxxx

Reference #3

(xxx) xxx-xxxx
(xxx) xxx-xxxx

How did you hear about CSI Controls?

I hereby certify that all information provided is true and authorize SJE, Inc. to contact trade and bank references for normal credit information.
The information being furnished to SJE, Inc. is for the purpose of extension of credit. The undersigned authorizes the above listed references
to provide SJE, Inc. with information regarding account history. This authorization may include, but is not limited to, obtaining a credit report.
A service charge of 1.5% per month may be incurred on all bills remaining unpaid after 30 days past agreed upon credit terms. If this account is
placed in the office of a collection agency or attorney for collections, the undersigned shall pay an amount equal to 25% of the unpaid principal
and interest as consideration for the extension of credit. This applies to the above business, and/or company, and/or successor companies.

mm/dd/yy
(xxx) xxx-xxxx

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