Credit Application

_{P. O. Box}₃₆₂₁₆_•_{Denver, Colorado 80236}_•_{Telephone (303) 744-7111}_•_{Fax (303) 744-3359}

_{To apply for credit print this page, fill out and fax to the attention of Credit Manager to the above number. You will be contacted within 10 days with the results of your request for credit}

Business Name ___________________________________________________________________

Business Address _________________________________________________________________

Mailing Address __________________________________________________________________

Telephone # ___________________________________ Fax# _____________________________

Social Security Number ____________________________________________________________

Federal ID # ___________________________________ Drivers LIcense # ___________________

Resale License # (if applicable) State _________________________________________________

Form of Business: Corporation _____________ Partnership ____________ Individual ___________

Name and Title of Principal __________________________________________________________

Home Address and Telephone _______________________________________________________

Bank Reference __________________________________________________________________

Bank Telephone # ____________________________ Bank Contact ________________________

Bank Address _______________________________ Account # ___________________________

Credit References: Name and Address Telephone # Fax #

_______________________________ _____________________ ____________________

Have you and/or any officers of your company ever filed bankruptcy? ________________________

If so, please give names and dates ___________________________________________________

How long has this company been doing business? _______________________________________

Who should we contact for billing problems? ____________________________________________

Amount of monthly credit desired? ____________________________________________________

Do you require Purchase Order numbers? ______________ Yes ________________ No

Can you furnish us with a current financial statement? __________ Yes ______________ No

Do you own or rent your home? ________________ Rent _________________ Own

List all of your vehicles and state whether or not they are financed:

Year and Model Financed

____________________________________ Yes ___________ No __________

Furnish us with a copy of your current workman's compensation certificate.
Furnish us with a copy of your current contractor's license.