CREDIT APPLICATION

Criteria First, Inc.

3303 Greenglen Cir.

Carrollton, TX 75007

972-492-4428

COMPANY INFORMATION

COMPANY NAME

LEGAL NAME OF COMPANY (if different)

PHONE

ADDRESS

CITY

STATE

ZIP CODE

# EMPLOYEES

TYPE OF BUSINESS

FEDERAL TAX ID #

DUNN AND BRADSTREET #

BUSINESS STRUCTURE

PARENT COMPANY

FIRST YEAR OF BUSINESS

$

CREDIT REQUESTED

Check if this account will be tax exempt.

Provide a copy of your tax exemption certificate.

COMPANY PRINCIPALS RESPONSIBLE FOR BUSINESS TRANSACTIONS

NAME

TITLE

PHONE

ADDRESS

CITY

STATE

ZIP CODE

NAME

TITLE

PHONE

ADDRESS

CITY

STATE

ZIP CODE

BANK REFERENCES

NAME OF BANK

BANK BRANCH

CHECKING ACCOUNT NO.

CONTACT NAME

ADDRESS

TELEPHONE NO.

TRADE REFERENCES

Provide at least three small business credit references. Include address, phone and fax numbers, and account number.

FIRM NAME

CONTACT NAME

PHONE #

FAX #

DATE ACCOUNT OPENED

CONFIRMATION OF INFORMATION ACCURACY AND RELEASE OF AUTHORITY TO VERIFY

By submitting this application, I hereby certify that the information in this credit application is correct. The information included in this credit application is for use by Criteria First, Inc. in determining the amount and conditions of credit to be extended. I understand that Criteria First, Inc. may also utilize the other sources of credit which it considers necessary in making this determination. Further I hereby authorize the bank and trade references listed in this credit application to release the information necessary to assist.

NAME

TITLE

DATE