Application For Credit

Crown Paper and Chemical Inc
Fax to 936-756-9543

Company Name__________________________________________Date____________
Billing Address_______________________________________________________
Billing Department Phone#________________Billing Fax #________________
Accounts Payable Contact(s)___________________________________________
Shipping Address______________________________________________________
PO# Required? Yes_____ No_____
Number Years in Business as this Name_____At This Location_____
BUSINESS/OWNER INFORMATION

Owner/Principle Name_________________________Title____________________
Bank_________________Acct.#_________________Contact___________________
Addr._________________________________________________________________
Phone#________________________ Fax#_______________________
Tax Status (attach certificate) ____Exempt Resale_______
TRADE REFERENCES

Firm______________________________Phone#_____________Fax#_____________
St.Addr.______________________________________Contact_________________
Firm______________________________Phone#_____________Fax#_____________ St.Addr.______________________________________Contact_________________
Firm______________________________Phone#_____________Fax#_____________ St.Addr.______________________________________Contact_________________
Firm______________________________Phone#_____________Fax#_____________ St.Addr.______________________________________Contact_________________

GUARANTEE AND CERTIFICATION

In consideration of credit being extended by Crown Paper and Chemical Inc. to applying company named on this form for merchandise or services purchased, the undersigned guarantor(s) each hearby contract to make all payments when due. We certify all information is true and correct on this credit application. We understand your credit terms. We authorize Crown Paper and Chemical Inc. to make any inquiries necessary for action on this credit application. We hearby indemnify Crown Paper and Chemical Inc and it's agents from any liability resulting from their credit review.
Should we become delinquent in payment, we agree to pay any collection costs to collect account balance including attorney fees.

Authorized Signature_____________________SS#_____________Date_______

Authorized Signature______________________SS#_____________Date_______