In-House Credit Application

Company Name

DBA

Physical Address

Phone

Fax

Mailing Address

City

State

Zipcode

Applicant is:

Corporation

Partnership

Sole Proprietor

Other...

FEIN/SSN

Years In Business

Type of Business

AMOUNT OF CREDIT REQUESTED

HAS PRINCIPAL OR COMPANY FILED BANKRUPTCY IN THE LAST TEN YEARS?

Yes

PRINCIPAL(S) OR GUARANTOR(S)

Name

Title/ %Ownership

Home Address/ Phone

SS#

Name

Title/ %Ownership

Home Address/ Phone

SS#

BANK REFERENCES (NO LESS THAN TWO YEAR HISTORY)

Name

Phone

Account #/ Type

Contact Name

TRADE REFERENCES

Company Name

City/State

Phone

Fax

Contact

Acct #

Company Name

City/State

Phone

Fax

Contact

Acct #

Company Name

City/State

Phone

Fax

Contact

Acct #

CREDIT RELEASE

I hereby authorize our banks, trade references, and financial institutions the right to release credit information to TEXOMA UTILITY EQUIPMENT , INCORPORATED an Oklahoma Corporation.

First and Last Name

Date

In-House Credit Application

PRINCIPAL(S) OR GUARANTOR(S)

BANK REFERENCES (NO LESS THAN TWO YEAR HISTORY)

TRADE REFERENCES

CREDIT RELEASE

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