Contact Information:

Date:*
Contact Person: *	Phone Number:*
E-mail address: *	Fax Number:*

Company Information

Company:*	FEIN or SS# :*
Address:*
City:* State:* Zipcode:*
Years in Business:* Annual Gross Sales:*
Owner/Controller: * Phone Number:*
Bank Name:* Account Number: *
Phone Number:* Address:*
City:* State:* Zipcode:*

Trade References:

Company:*	Phone Number:*
Contact Name: *	Address:*
City:* State:* Zipcode:*

Company:	Phone Number:
Contact Name:	Address:
City: State: Zipcode:

Company:	Phone Number:
Contact Name:	Address:
City: State: Zipcode:

This credit application and the information contained herein is a request for the extension of credit by Pelham Services CA Corp. and the applicant authorizes any bank or commercial business with which the applicant is doing business or has done business, to give any and all necessary information to the creditor. The applicant further authorizes the creditor to investigate the applicant’s credit status from time to time as the creditor deems necessary. Should creditor upon such investigation deem it necessary, creditor may limit or terminate the credit arrangement with the applicant

Upon approval, terms of credit will be as per each individual contract, and the applicant agrees to pay a service charge at the rate of 1 ½% per month (18% per annum) for late payments of any invoice. Applicant agrees to pay all collection or attorney’s fees, related costs and interest charges for any unpaid balance placed for collection.

Company Name:*

Owner/Office Signature:*

Title:* Date:*

Personal Guaranty:

I,in order to induce Pelham Services CA Corp. to extend credit, hereby guarantee to Pelham Services CA Corp. the prompt payment when due of every invoice of Pelham Services CA Corp. which presently exists or which may hereafter arise against the company.

This is a continuing guarantee and shall remain in full force until revoked by written notice. Such revocation shall be effective only as to credit extended after receipt of notice of revocation.

Please e-mail or fax back to attention: Gabriel Reveron

Ph. # 323-201-4995

Fax # 323-201-4998

gabrielreveron@pelhamservices.com

Thank you for your business!