Credit application from

GENERAL INFORMATION
* Invoices and statements are only sent electronically. Please provide a designated email account.
PROPRIETOR, PARTNERS OR CORPORATE OFFICERS*

(Please provide alternate address where we can reach you)

* By signing this credit application, I authorize the person(s) listed on this credit application to carry out security related duties for the company. Social security number required in order to carry out security-related duties for the company.
DESCRIPTION OF BUSINESS
Corporation
Partnership
Proprietorship
Yes
No
(documentation must be presented before exempt status given)
BANKING INFORMATION

(optional)

TRADE REFERENCES

(optional)

REFERENCE #1
REFERENCE #2
REFERENCE #3
CREDIT INFORMATION

(optional)

Yes
No
Yes
No
TYPE OF BUSINESS
Restaurant
General Contractor
Hospital
Hotel/Motel
Food Service Management
Property Management
Nursing Home
Church
Other
Bld/Facility

(optional)

Owned
Leased
Rented
Permission is hereby granted to obtain credit information from listed credit references including my bank. All financial information submitted in support of this new account and credit application is true and complete in all respects. My account is subject to a late charge of 1.5% per month (18% annual) on all past due invoices. Furthermore, I understand that my account may be turned off if my account is past due and any collection fees (including attorney fees) incurred by MPRS, which the parties hereby fix at 33 1/3% of any balance due plus court costs, will be borne by my account. By signing this credit application, I certify that I am authorized to make this request on behalf of the company and it is agreed that all purchases will be paid in accordance with the terms and conditions.

I assume personal and individual responsibility and liability, as well as guarantee payment of all charges due and payable to MPRS by the company listed here-in. I hereby consent and autorize the use of my consumer credit report in the credit evaluation proccess.

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