EFTA02686069

TENSERVE 119 West 23rd St. New York, NY 10011 (212) 929-3645 Fax (212)463-9280 [email protected] www.tekserve.com Credit Application COMPANY INFORMATION Company Name Billing Address D&B # City/State/Zip Type of Business: Phone Fax Parent Company? Accounts Payable Contact: Phone: Accounts Payable Email: Computer Repair Contact: Phone: Computer Repair Email: Who is your sales/service contact at Tekserve? Resale/Tax Exempt # (attach copy ) 0 N/A BANK REFERENCE Bank Name Account # Address City/State/Zip Phone Fax Contact TRADE REFERENCES We depend on Dun & Bradstreet recommendations; if you are not listed, we will not be able to extend credit. 1. Company (one must be local) Contact Address Phone 2. Company Contact Address Phone 3. Company Contact Address Phone CREDIT CARD GUARANTEE (OPTIONAL) A credit card guarantee will make it much easier for Tekserve to extend you credit. If Tekserve doesn't receive payment within terms, I authorize Tekserve to put the charges on our credit card. Name on Credit Card Card # Expiration AGREEMENT Tekserve requires a purchase order for all sales and service. Tekserve's billing terms are net20 days. Tekserve will add sales tax for all items and services delivered within New York State, unless a tax exemption form is attached. This letter authorizes the bank and vendors named above to release credit and payment information to Tekserve, and authorizes Tekserve to obtain credit a business information regarding your company from credit reporting agencies and other suppliers. If the credit card guarantee is filled out above, this authorizes Tekserve to charge that card. Signature Date Print Name Title Email EMAIL COMPLETED FORMS TO [email protected] OR FAX TO (212) 463-9280 Please allow five business days for the application to be processed. EFTA_R1_02010929 EFTA02686069