Credit Application

Date:_________________Maximum credit applied for: _________________
Name of Firm:
Street Address:
Phone #:
Mailing Address:
Fax #:
City:
State:
Zip:
Kind of Business:
Year Established:
Incorporated:
Bank Affiliation:
Phone #:
Bank Address:
Account #:
Authorized Buyers: 1.
2.
3.
Are Purchase Orders Required to Charge Your Account?

Business References:
1. ________________________ 2. ________________________ 3. ________________________
Name Name Name
________________________ ________________________ ________________________
Address Address Address
________________________ ________________________ ________________________
Phone # Phone # Phone #

It is agreed that all purchases made in any particular month from Cornerstone Solutions, Inc. will be due and payable by the tenth day of the following month.

By (Signed) ______________________________________________________________

(Printed) _________________________________________________________________

If you have any questions Please call us at (713)661-5200.
You can fax this form back to us at (713)661-5096.

We Look Forward to Working with You in the Future ! ! !

FOR CREDIT DEPARTMENT USE ONLY:
Length of Time Sold: 1. 2. 3.
High Credit:
Pays When Due:
Other Comments:
Credit Limit Authorized:
Authorized By:

Date:



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For comments or questions, email us
info@cornerstonesolutions.com
or contact us at:
Cornerstone Solutions, Inc., PO Box 270514, Houston TX, 77277-0514
Phone: 713-661-5200    Toll Free: 877-661-5200
Copyright © 1987-2006 Cornerstone Solutions, Inc. All rights reserved.