New Customer Credit Application

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Thank you for giving us the opportunity to do business with your company.

Please find the attached sales application. If you have an information sheet, please attach in the box at the end of the form. Complete any items in the sales application not contained in your information sheet, then sign by typing your name.

Company

Business Name:

Phone:

Area Code

Phone Number

Invoice E-mail or Fax #:*

Mailing Address:

Mailing Address Mailing Address Line 2 City State / Province / Region Postal / Zip Code Country

for how many years:

Shipping Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Previous Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

D/B/A/:

Federal ID:

Company Email Address:

No. of employees:

Est. annual sales:

Sales area:

Has the firm or any of its Principals ever been bankrupt?

yes

If yes, explain:

Principals

Principal #1:

Principal #1 home address:

Principal #2:

Principal #2 home address:

Principal #3:

Principal #3 home address:

Trade References

(List 3 major suppliers of steel)

Trade Ref. #1:

Trade Ref. #1 Email:

Trade Ref. #1 Phone:

Trade Ref. #2:

Trade Ref. #2 Email:

Trade Ref. #2 Phone:

Trade Ref. #3:

Trade Ref. #3 Email:

Trade Ref. #3 Phone:

Customer References

(List your 3 largest customers)

Customer ref. #1:

Customer ref. #1 contact:

Customer ref. #1 phone:

Customer ref. #1 Terms and duration:

Customer ref. #2:

Customer ref. #2 contact:

Customer ref. #2 phone:

Customer ref. #2 Terms and duration:

Customer ref. #3:

Customer ref. #3 contact:

Customer ref. #3 phone:

Customer ref. #3 Terms and duration:

Bank References

Checking Name:

Checking Contact:

Checking Phone:

Checking approx. balance:

Loans #1:

Loans #1 Contact:

Loans #1 Phone:

Loans #1 approx. balance:

Loans #2:

Loans #2 Contact:

Loans #2 Phone:

Loans #2 approx. balance:

Credit Line:

Credit Line balance:

Credit Line amount available:

Customer agrees to pay within credit terms, which are 1/2% discount in 10 days or net 30 days.

Applicant agrees to pay any collection costs incurred to collect the account balance, including court costs, collection fees and attorney’s fees of not less than 33% of the unpaid balance.

As an inducement to extend sales, the undersigned agrees to the need for verification of all information on this application and authorizes, and releases all banks, businesses and persons identified on this application to furnish any and all information requested by Miami Valley Steel Service, Inc. or its representative, by telephone or written correspondence whichever Miami Valley Steel Service, Inc. requests.

The undersigned warrants that the information is true and correct. As an inducement to extend sales, the undersigned agrees that Miami Valley Steel Service, Inc. has the right to obtain in the credit history of the undersigned and authorizes the release of such information by signature here:

Digital Signature:*

Attach info sheet:

*****ATTENTION*****
SIGNED SALES TAX EXEMPTION CERTIFICATES FOR THE STATES WE WILL DELIVER TO ARE REQUIRED BEFORE SHIPMENT.