Kasparian S Paint Center

KASPARIAN’S PAINT CENTER 4635 N CEDAR AVE., FRESNO CA 93726 PH# (559) 222-3131 FAX# (559) 222-3339 CREDIT APPLICATION

Account No. ______Salesman’s Name __Doug Galley______Date ______*Fill this out for a Business Acct. Name of Business: ______Telephone No: (___)______Business Address: ______Fax No: (___)______City: ______State: ______Zip: ______-_____ How Long? ______Previous Address: ______How Long? ______Ownership: ____ Corporation: ____Partnership: ____Proprietorship Date Est: ______Federal Tax ID#:______-______Principal’s Name: ______Address: ______SS#: ______Phone# (___)______Title: ______*Fill this out for a Personal Acct. Name: ______Telephone # (__)______Address: ______City: ______State: ______Zip:______SS#______Date of Birth: ___/___/____

Credit References *Must be completed in full or provide a separate credit reference list. Name: ______Ph#:(__)______Fax#:(__)______Address: ______Acct#:______Name: ______Ph#:( )______Fax#:(__)______Address: ______Acct#:______Name: ______Ph#:( )______Fax#:(__)______Address: ______Acct#:______

Bank References Name:______Branch:______Acct#:______Address:______City:______State:______Zip:______Indicate Accounts: _____Checking ______Savings ______Other ______(______) (Business Only) Your Office Contact: ______Ph. #: (__)______Terms Agreement Terms are 2% 10th Approx. Net 30. A service charge of 1.5% monthly, 18% yearly applies to accounts 60 days past due. Customer agrees to pay reasonable attorney fees and other costs of collections in the event of default. Signed______Title______Date______Print Name______*A PO# is required on all our orders Yes or No - A Job name is required on all our orders Yes or No Acct Payable Contact ______Phone Number ______Fax Number______Email ______Please mail an original W-9 form to the address shown above. If this account will be resale, please call and we will fax a resale form to you. Thank you for your interest in Kasparian's Paint Center and our quality line of Paints, Coatings, Equipment, Applicators and Service.