Credit Application

EMS

Electric Motor Specialists, Inc.

Business Contact Information

Title:

Company Name: Phone: Fax: Email:

Registered Company Address: City: State: Zip Code:

Date Business Commenced:

Sole Proprietorship: Partnership: Corporation: Other:

Business and Credit Information

Bank Name:

Bank Address:

City: State: Zip Code:

Phone: Fax: Email:

Type of Account: Checking: Savings: Other:

Account Number:

Business and Trade References

(1)

Company Name:

Address:

City: State: Zip Code:

Phone: Fax: Email:

Type of Account: Terms:

(2)

Company Name:

Address:

City: State: Zip Code:

Phone: Fax: Email:

Type of Account: Terms:

(3)

Company Name:

Address:

City: State: Zip Code:

Phone: Fax: Email:

Type of Account: Terms:

Agreement

1. All invoices are to be paid 30 days from the date of the invoice.

2. Claims arising from invoices must be made within 4 business days.

3. By submitting this application, you authorize EMS, Inc. to make inquiries into the banking and business/trade rederences that you have supplied.

Signature

Title:

Date:

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