Credit Application

CREDIT APPLICATION Company Name: Contact: Billing Address: City: State: Zip Code: Shipping Address: City: State: Zip Code: Phone: FAX: E - mail: Type of Business: In Business Since: Form of Business: [ ] Corporation [ ] LLC [ ] Partnership [ ] Sole Proprietor Is a Purchase Order required? Name of individual wit h authorization: If it is to be a blanket PO, please list the number and expiration date. Number Expiration Date To whose attention should invoices be sent? Is your work taxable? If not, please attach signed certificate and list your tax exempt or resellers number: If you which to pay by credit card, please provide information below: VISA Card Numb er Exp. Date MasterCard Number Exp. Date American Express Card Number Exp. Date 2001 251 American LegalNet, Inc. Bank Reference s (please list name and address of local banks): Trade References (Please list name, address, phone number, and account number of three references. Do not list credit cards.) Our terms are net 30 days. Accounts not paid in this time frame will be charged 1.5% interest rate per month and future orders will be on a C.O.D. basis until the account is current. Should collection or legal action be required to collect past dues, fees for such acti on will be added to your account. Print Name: Title: Signed by: Date: 2001 251 American LegalNet, Inc.