Legal Status: __________Corporation _________Partnership ________*Proprietorship_________LLC

  

Tax ID#___________________ Social Security Number______________________________

                                                           *Proprietorship requires a Social Security No.

State & Date of Incorporation:__________________________________________________________

  

Name of Business:___________________________________________________________________



Billing Address:____________________________________  Contact:__________________________

  

City:___________________________________________State:___________Zip Code:____________

 

Shipping Address:__________________________________  Contact:__________________________

  

City:___________________________________________State:___________Zip Code:____________

Phone:__________________________Fax:_________________________ Years in Business:_______

  

Description of Business:_______________________________________________________________



Annual Sales:_________________________________________ No. of Employees:_______________

Website:_______________________________________ E-mail address: _______________________

Name of Officers, Partners, or Proprietor:



1.____________________________________________Title:_________________________________

  

2.____________________________________________Title:_________________________________

  

3.____________________________________________Title:_________________________________

         

Parent Company:_____________________________________________________________________

    

City:__________________________________________State:_______________ Zip Code:_________



Bank Name:___________________________________Account No.:___________________________

     

Contact:______________________ Phone No.:_____________________ Fax No.:________________

  

Trade References: (affiliated companies cannot be considered as references)

  

1.____________________________ Phone No.:_____________________ Fax No.:________________

    

2.____________________________ Phone No.:_____________________ Fax No.:________________

    

3.____________________________ Phone No.:_____________________ Fax No.:________________



4.____________________________ Phone No.:_____________________ Fax No.:________________



Has this company been involved in any bankruptcy proceedings?____(Please provide details on separate sheet if 

applicable.)

Have any principles of this company been involved in bankruptcy proceedings under the name of any other

company?________(Please provide details on separate sheet if applicable)

Are there any open law suits for nonpayment or any other obligations or unsatisfied mechanics or

tax liens?________ (Please provide details on separate sheet if applicable)

The undersigned ("DEBTOR") hereby makes this application to Toner Cable Equipment,Inc.("CREDITOR") 

and in making this application the undersigned agrees that all amounts payable on or before the due date, as 

shown on each invoice, shall be paid, and if not paid on or before said date, are then delinquent. Should 

credit availability be granted by creditor, all decisions with respect to the extension or continuation of credit

shall be in the sole discretion of creditor. Creditor may terminate any credit availability within its sole 

discretion. It is understood that creditor may impose and charge a finance charge or delinquency charge

which is the lower of one and one half percent (1-½%) per month or the highest rate allowed by law on any

amount which becomes past due and delinquent. Additionally, if legal proceedings are instituted for the 

collection of any amount unpaid on the undersigned's account ("evidence of indebtedness") with creditor, the

debtor agrees to pay,in addition to the outstanding balance, reasonable attorney's fees in accordance with 

applicable law.

Terms and Conditions of Sale: The undersigned agrees to pay for all billings according to the terms of 

creditor which are NET 30 DAYS. No terms or conditions of purchase orders different from the terms of 

creditor will become part of any sales agreement, purchase order, or other document unless specifically 

approved in writing by creditor. Payments may be applied against open charges in the discretion of the 

creditor. On request the undersigned agrees that the continued solvency of the undersigned is a precondition 

to any sale made by creditor. The undersigned agrees to provide creditor a statement representing that the 

undersigned is and remains solvent. The undersigned acknowledges and agrees that creditor may utilize 

outside credit reporting services to obtain information on the undersigned. The laws of the State of

Pennsylvania shall be applicable to all suits arising under any agreement between the undersigned and the 

creditor. 

The person signing this application certifies that he/she is authorized to sign on behalf of the

undersigned and has the authority to legally bind the undersigned and that all of the information contained

in this application, is true and correct to the best of their information, knowledge and belief. Applicant, in 

submitting this application for the purpose of obtaining credit, authorized creditor company to contact the

 references provided to obtain any information pertaining to the applicant's credit worthiness.

NAME OF APPLICANT:______________________________________________________________

                                     (PRINT OR TYPE)

SIGNATURE:______________________________________________________________________

           (IF A CORPORATION TO BE SIGNED BY OFFICER OF COMPANY) 

TITLE:___________________________________________________________________________

WITNESS:____________________________________ DATE:______________________________

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