CREDIT APPLICATION

P.O. Box 542885 - Dallas. TX 75354

Business Name: __________________________________________________________________________ Since: _____________________

( ) Proprietorship

( ) Partnership

# of Locations: _____________

( ) Corporation

If corporation, what state: ___________________________

Annual Company Sales Volume:______________________

Physical Address: ______________________________________________________________________________________________________

Address

Billing Address:

City

State

Zip

______________________________________________________________________________________________________
Address

City

State

Zip

Phone: ______________________ Fax: ______________________ Web: _______________________________________

Former Business Name: __________________________________________________ Years in Business: _______________
Address: ________________________________________ City: ____________________ State: ______ Zip: _____________
CONTACT INFORMATION:
Purchasing: ___________________________________________ Phone: _________________________

Fax: _________________________

Cell: _________________________ E-mail: _________________________

Payables:

___________________________________________ Phone: _________________________

Fax: _________________________

Cell: _________________________ E-mail: _________________________

PRINCIPALS:
Name: __________________________________________________ Title: _________________________
Phone: _____________________ Fax: _____________________ Cell: ____________________ E-mail: ________________________
Name: __________________________________________________ Title: _________________________
Phone: _____________________ Fax: _____________________ Cell: ____________________ E-mail: ________________________
Name: __________________________________________________ Title: _________________________
Phone: _____________________ Fax: _____________________ Cell: ____________________ E-mail: ________________________

BANK REFERENCES:
Bank Name: ______________________________________________________________ Account #: ____________________________________
Address: _____________________________________________________ City: _______________________ State: ______ Zip:______________
Banking Officer: __________________________________________ Phone: _________________________ Fax: __________________________
Do you authorize All-Tex Pipe & Supply to receive information from the above named bank regarding your account status?
YES NO

If no, why? ___________________________________________________________________

Has this company or any of the company principals ever filed for bankruptcy.

If yes, when? ___________________________

DALLAS FORT WORTH SAN ANTONIO AUSTIN BEAUMONT HOUSTON

Your PVF Specialist . . .

Well take it from here!

CREDIT APPLICATION

Page 2

TRADE REFERENCES: (To process your application in a timely manner, a fax number is required.)
Company Name: ______________________________________________________________________

Since: _________________________

Address: ____________________________________________ City:______________________ State: _______ Zip: ______________

Phone: _______________________ Fax: __________________________
Company Name: ______________________________________________________________________

Since: _________________________

Address: ____________________________________________ City:______________________ State: _______ Zip: ______________

Phone: _______________________ Fax: __________________________
Company Name: ______________________________________________________________________

Since: _________________________

Address: ____________________________________________ City:______________________ State: _______ Zip: ______________

Phone: _______________________ Fax: __________________________
Estimated amount of credit required each month: _______________________________
All Purchases Tax Exempt: No __________
Texas Sales Tax Number:

Yes __________

If yes, must enclose sales tax certificate.

_______________________________________

Purchase Order Number required for all purchases?

No __________

Yes __________

For the consideration of the extension of credit to the above firm, I/We promise to pay to the order of All-Tex Pipe & Supply at their offices in Dallas,
Dallas County, Texas, all charges to the account of the firm shown above on or before the due date. In the event said account becomes past due five (5)
days or more, I/We agree that interest shall be added at the rate of 1 1/2% per month, (18%) per annum) from date until paid; and that in the event
payment is not made on or before the due date, and the account is placed in the hands of an attorney for collection or suit or the same is collected
through probate or bankruptcy proceedings, then an additional reasonable amount shall be added to the same as attorneys fees.

Signature: __________________________________________________
Name (Print or Type): ___________________________________________
Title: ______________________________________________________
(Owner, Partner, Officer)

Date: ______________________________________________________
I, the undersigned, personally guarantee the prompt and unconditional payment of all charges in the above account.
Signature: __________________________________________________
Date: ______________________________________________________

Please fax or mail applications to:

All-Tex Pipe & Supply, Inc.

Attn: A/R Dept.
P.O. Box 542885
Dallas, TX 75354
Fax: 214-353-0449