CREDIT APPLICATION FOR OPEN ACCOUNT

Company Name:
Street Address:
City:	State:   Zip:
Phone:
Fax:
Type of Business:	Corporation Co-Partnership Limited Partnership Individual Proprietor
Years Established:
If a branch office or a division, give name of parent company and home office:
Where should accounts payable statements be mailed to?
Credit Desired:	$ per month
Select One:	Goods Purchased ARE for Resale Goods Purchased ARE NOT for Resale
Resale Number:
Tax Rate:	%
Select One:	A PO or Requisition WILL be Issued Prior to Purchase A PO or Requisition WILL NOT be Issued Prior to Purchase
What Product(s) Are You Interested In:
How Did You Hear About Optex:
Principal Owners - Stockholders - Partners - Officers of Company
Name & Title:
Address:
City:	State:   Zip:
Name & Title:
Address:
City:	State:   Zip:
Name & Title:
Address:
City:	State:   Zip:
List Persons Authorized to Make Purchases
Name & Title:
Name & Title:
Name & Title:
Trade References: All fields required
Name & Contact:
Address:
City:	State:   Zip:
Account #:
Phone #:
Name & Contact:
Address:
City:	State:   Zip:
Account #:
Phone #:
Name & Contact:
Address:
City:	State:   Zip:
Account #:
Phone #:
Bank References: All fields required
Bank Name & Contact:
Address:
City:	State:   Zip:
Account #:
Phone #:
Bank Name & Contact:
Address:
City:	State:   Zip:
Account #:
Phone #:
Additional Information:
By clicking "Submit" below, applicant hereby agrees that Optex Incorporated shall maintain right of possession for all materials until such time as payment has been received. It is further agreed that in the event of legal action, jurisdiction shall be Los Angeles County, California, and that this agreement is covered by the laws of the state of California. Applicant further agrees to reimburse Optex Incorporated for all reasonable legal and collection expenses resulting from collection efforts, including attorney fees, filing fees, and court costs. Applicant personally guarantees payment for all charges as a result of this application, and hereby authorizes Optex incorporated to conduct whatever credit investigation is required to establish and maintain this credit account. It is understood that our credit terms are Net 30 Days and that late charges at the maximum rate allowed by law are added on all past due accounts.