CREDIT APPLICATION

Company Name							Date
Address							Yearly Sales
Contact Person		Telephone No.		Fax No.		Fax No.        (                  )	Number of Employees
						(201) 837-0504
	E-Mail address			Web Site
Personal Information -please use the full legal name
Name
Address				City	County		State	Zip
Telephone No.         (               )		Fax No.         (               )		Contact  Person			Title
Nature of Business			Type of Business(circle one)				No. of Years in Business
			Corporation	Proprietorship	Partnership          LLC	Corporation
Landlord/Mortgage Holder at Business Location			City/State		Telephone No.		Contact Person
PERSONAL INFORMATION ON OFFICERS, PARTNERS, OR GUARANTORS
Name			Social Security No.		Title		Driver's License No.
Home Address			City		State	Zip	Home Phone No.        (               )
Name			Social Security No.		Title		Driver's License No.
Home Address			City		State	Zip	Home Phone No.        (               )
COMPANY BANK REFERENCES -			How Long?	Chkg. Acct.#			Phone Number & Contact
Name of Bank/Branch						Telephone No.        (               )
				Loan Acct. #
Previous Bank (If current account is less than two years old)			How Long?	Chkg. Acct.#		Telephone No.        (               )	Phone Number & Contact
				Loan Acct. #
TRADE REFERENCES
Name of Supplier			Contact Person			Telephone No.        (               )	Phone Number
Name of Supplier			Contact Person			Telephone No.        (              )	Phone Number
Name of Supplier			Contact Person			Telephone No.        (              )	Phone Number
I/We grant Pearl Computer Services, Inc. the right to procure any and all credit reports pertaining
to any party listed in this application, including, but not limited to, all principals of the applicant company.
The foregoing information is true and correct to the best of my knowledge and is given to Pearl Computer
Services, Inc. in order to establish Net terms.  I do hereby authorize Pearl Computer Services, Inc.
or its agents to verify and investigate any or all of the foregoing, including but not limited to my/our
credit worthiness and financial responsibility, in any way they may choose.
PERSONAL GUARANTEE: I assume personal and individual responsibility and liability and GUARANTEE PAYMENT OF ALL
charges due and payable to Pearl Computer Services, Inc. by the company or corporation listed herein.
Agreed and consented to: _________________________  Print Name: _________________________
Title: ___________________________  Date: _______________