Net Terms Credit Application

Company:

Phone:

Fax:

Bill To

PO Box :

City:

State / Zip:

Accounting Contact:

PO Required:

Credit Information:

Ship To

Street Address:

City

State / Zip

Receiving Contact

Alternate Contact

Credit Information

? Corporation ? Partnership ? Proprietorship ? Non Profit or Religious

Date of Incorporation

State of Incorporation

Years in Business

Previous Business Name

Bank Name

Bank Account Number

Bank Phone

Bank Contact

DUNS Number

Federal ID Number

Trade References

Vendor Name

Account Number

Street Address

Contact Name

City / State / Zip

Phone

Vendor Name

Account Number

Street Address

Contact Name

City / State / Zip

Phone

Principals / Owners / Officers

Name

Title

Phone

Name

Title

Phone

The Undersigned warrants that he / she has full authority to act on behalf of the above named company. The above statements are true and
correct and are given for the purpose of obtaining credit. In the event credit is extended, the undersigned agrees to the following terms and
conditions: 1) Pay for all purchases pursuant to the terms of the seller’s invoices “Net 30 Days”, 2) pay seller a delinquency charge of
1.5% per month on any amounts unpaid 30 days or more after the invoice date, 3) pay seller reasonable attorney fees and costs incurred in
connection with enforcement of collection of any obligation of the purchaser, 4) to pay all sums due to seller at it’s address in Collin County,
Texas, such county being agreed upon as the county of venue for any suit brought by either party.
PERSONAL GUARANTY: “The undersigned, in consideration of the extension of Credit by The Laser Network to the above named
corporation, hereby personally and unconditionally guarantee payment of any and all amounts now or hereafter owed by Customer to The
Laser Network. I (we) further agree that if it becomes necessary for The Laser Network to incur costs in e

Submitted by (Signature)

Title

Printed Name

Date