CREDIT SALES APPLICATION

Print this Form, Fill in Completely and Fax back to 440 891-1025.              Allow 1 to 3 Days for Approval

Network Analysis SCS, Inc.                                                Phone 440 773-4554

119 Sunset Drive

Berea, OH 44017    

Company Information

Company Name ________________________________________________________ Phone __________________________________

Company Address ______________________________________________________________________________________________

Yrs in Business ____________ Landlord _____________________________________ Landlord Phone __________________________

Estimated Annual Sales _______________________ Fed. ID# or SS # _________________________

Circle one: Incorporated   Partnership   Individual

Owners, Principals and Officers

Name ___________________ Title ___________ Address ________________________ Phone _______________ SS# _____________

Name ___________________ Title ___________ Address ________________________ Phone _______________ SS# _____________

Name ___________________ Title ___________ Address ________________________ Phone _______________ SS# _____________

Trade References

Name _________________________ Address ________________________ Phone ________________ Contact __________________

Name _________________________ Address ________________________ Phone ________________ Contact __________________

Name _________________________ Address ________________________ Phone ________________ Contact __________________

Bank References

Bank ___________________________________ Address ______________________________ Phone __________________________

Banker Name _____________________________ Circle one:  Savings    Checking    Loan     Acct # ____________________________

Credit Terms are 15 days from date of invoice.  Outstanding balances are subject to 1.5% per month interest.  The undersigned authorizes and

releases all banks, persons and companies listed on this application to furnish information and authorizes the checking of credit. 

The undersigned agrees to pay all collection costs, court costs, and legal fees incurred to collect delinquent balances.

25% Re-Stock Charge on all Orders.

____________________________________ _____________       __________________________________________ _______________

Name                                   Title                                   Date                   Name                                     Title                                    Date

Personal Guarantee

In consideration for credit extended, the undersigned contracts and guarantees to the faithful payment, when due, of all accounts of the company

 seeking credit for 5 years from the date of this application.  The undersigned guarantor expressly waives all notice of acceptance of this guarantee,

notice of extension of credit, presentment of demand for payment and any notice of default by the company seeking credit and all other notices

the guarantor might be entitled to.  Revocation of the guarantee shall be in writing and delivered by certified mail.

____________________________________ _____________       __________________________________________ _______________

Name                                    Title                            Date                   Name                                                 Title                      Date

THIS IS CONFIDENTIAL INFORMATION & PRIVACY PROTECTED