Open Account Credit Application

OPEN ACCOUNT CREDIT APPLICATION Business Name: Billing Address: Sh ipping Address: Phone: Fax: Name of Parent Co. ( If Subsidiary ): Type of Business: ( ) Individual ( ) Partnership ( ) Corporation Number of Years in Business: Federal Tax Number: Social Security Number: PROPRIETOR, PARTNERS OR OFFICERS Name: Title: Home Address: Phone: Name: Title: Home Address: BANK REFERENCE Name: Account Number: Address: Phone: 2001 251 American LegalNet, Inc. TRA DE REFERENCES Name: Phone: Address: Contact : Name: Phone: Address: Contact : INDIVIDUAL RESPONSIBLE FOR PAYMENT OF ACCOUNT Name: Title: The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize the firm to whom the application is made to investigate the references listed pertaining to my/our credit and financial responsibility. Business Name: Authorized Signature: Date: 2001 251 American LegalNet, Inc.