Miller Blueprint Credit Application

Print and fill in this form, then mail or fax to one of the locations listed below.

Company Name__________________________________________________________________________

Billing Address___________________________________________________________________________

Shipping Address_________________________________________________________________________

Phone Number______________________________ Fax Number___________________________________

Ownership Status:   Corporation  Partnership  Sole Proprietorship  Other_______________________________

Type of Business____________________________ Year Established________________________________

Federal Tax ID Number (Social Security No. For Individuals)________________________________________

Please List Names, Titles and Addresses of Officers or Partners:______________________________________

Bank References

Include bank name, complete address, phone number and account number. You must have at least six months banking history.

(1)____________________________________________________________________________________

(2)____________________________________________________________________________________

Trade References

Business name, complete address, phone number and account number (Please do not use utilities):

(1)____________________________________________________________________________________

(2)____________________________________________________________________________________

(3)____________________________________________________________________________________

Dun and Bradstreet No.__________________________

Each signature below attests to the financial responsibility, ability and willingness of applicant to pay all invoices submitted by Miller Blueprint Company in accordance with the terms and conditions pertaining thereto. The person or persons signing this application below hereby each personally guarantees in full all obligations and liabilities made, entered into and incurred by or on behalf of the applicant. Miller Blueprint Company makes this guarantee as a condition of the extension of credit to the applicant. Both the applicant and guarantor or guarantors hereby authorize Miller Blueprint Company to investigate with the references listed as to the credit and financial responsibility both of applicant and of the guarantor or guarantors.

Signature_________________________________________________ Date__________________________

Print Name____________________________________ Title______________________________________

Social Security Number_______________________

Terms: Net 10th

501 West 6th Street
Austin, Texas 78701
512-478-8793(phone)
512-477-7492(fax)

10713 Metric Blvd.
Austin, Texas 78758
512-837-8888(phone)
512-834-9165(fax)