Credit Application 1250 Addison Street, Suite 109, Berkeley, CA  94702 Tel/Fax: (510) 883-0783
		Name:
		Address:
		City			State	Zip Code
		Telephone: (            )               -
		Fax: (           )            -
		Check One: ___Corporation    ___Partnership    ___Proprietorship     ___Individual
		Years in Business: _____
		Owner:
		Address:
				City	State	Zip	Home Phone		Cell Phone
		President/Manager:				Cell Phone:
		Accounts Payable Contact:				Cell Phone:
		Bank Name:
		Address:
				Address		City	State		Zip Code
		Telephone: (         )          -
		Account No.:
		Contact:
				Business	Address	City	State	Zip   Telephone	Fax
		1
		2
		3
		4