FROM: 

PAT TURNER
CREDIT DEPARTMENT
PHOTO CHEMICAL SYSTEMS, INC.

We appreciate your interest in obtaining an open credit account with Photo Chemical Systems.  In order to process your application as quickly as possible, be sure to note the following items that are sometimes overlooked that could delay the processing of your application.

• Completion of all sections.
• Attachment of a copy of your tax exemption certificate.  Tax registration FORM or NUMBER is NOT sufficient.
• Current fax and phone numbers provided for references.
• Appropriate signatures for the personal guarantee section.
• Authorization signature at the bottom of the application form.  Applications can NOT be processed without this authorization signature.

Please complete all sections of this application. Missing information and/or signatures may delay credit approval. 

Company Name ________________________________  Phone #_____________ Fax#______________ 

Billing Address_______________________________  City________________  State_____  Zip_______ 
Shipping Address_____________________________   City________________ State_____  Zip_______ 

Date Established________________ Parent Company:_______________________________________ 

Former Business Name/Address (if less than 5 years)_________________________________________ 

Has the firm or any of its Principals ever filed bankruptcy? ________Yes ________No   (If yes, explain) 

_________________________________________________________________________________ 

_________________________________________________________________________________ 

Credit Contact___________________________Phone #__________________  Fed. I.D.#____________ 

TAX STATUS:     ___Direct Pay     ___Exempt-Resale     ___Exempt-Mfg    ___Fully Taxable 

COUNTY IN WHICH BUSINESS IS LOCATED:  ___________________________ (required) 

(THE PROPER SALES EXEMPTION CERTIFICATE MUST BE PROVIDED IN ORDER TO AVOID
APPLICABLE TAXES BEING CHARGED.)

References

   Bank_______________________ Acct. #_______________ Contact_____________ Tel___________ 

TRADE: (Minimum of three required, do not list D&B, name suppliers of major products. Fax numbers are required)

   Company_______________________________ TEL:_________________ FAX:__________________ 

   Company_______________________________ TEL:_________________ FAX:__________________ 

   Company_______________________________ TEL:_________________ FAX:__________________ 

Personal Guarantee

 In consideration of credit being extended to the above named applicant, the undersigned guarantor(s) each contract and guarantee to make faithful payment, when due, of all accounts of the applicant. The undersigned guarantor(s) each expressly requests notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment or demand for payment and any notice of default by applicant. Revocation of guarantee shall be in writing and delivered by certified mail to: (Complete name and address required for notification.) 

_________________________________              __________________________________________ 
Name (Signature) Address 

_________________________________             ___________________________________________ 
Name (Signature) Address 

The foregoing statement has been made to Photo Chemical Systems for the purpose of obtaining credit merchandise. The undersigned is authorized to make application for credit with Photo Chemical Systems on behalf of the above business name address and in support of such application makes the following statements: 

 1) We authorize Photo Chemical Systems to make inquiry from references given and other commercial and financial credit sources for verification for credit reliability. 

2) We accept your credit terms of NET 30 DAYS. 

3) We understand that all products are sold without warranties expressed or implied. 

4) We agree 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 principal.

SIGNED______________________________________ PRINT NAME_________________________ 

TITLE________________________________________ DATE________________________________