Computer Spectrum, Inc.

908 South 8th Street

Louisville, KY  40203   502-585-8866      

502-585-8869  FAX 

Date: Sales Rep.
D/B/A: Owned By:
Business Address Tel:
Contact Person Tax ID or SNN:
Parent Co. Address
Tel: Fax:  
Home Address: Tel:
Officers and Principals
Name: Title:
Name: Title:
Company Information:    Corporation / Partnership / Proprietorship / Franchise
Date Company Established:      /      /     
Type of Business
Names previously used for advertising:
 

Trade Reference 1

Company Tel: Acct. #
Address: Contact:

Trade Reference 2

Company Tel: Acct.#
Address: Contact:

Trade Reference 3

Company Tel: Acct. #
Address: Contact:

Loans or Mortgages

Bank Address:
Fax: Acct. Original Amount:
Balance: Loan Date:  

Acceptance of Terms

       Upon approval of this application, a 20-day account will be opened for your convenience. All bills are due in our office within 20 days of the date of each invoice. A late charge will be added to all amounts not paid within 20 days from date of invoice at the rate of one and one-half percent (1.5%) per month or 18 percent per annum.
       If failure to pay according to the terms of the agreement causes this account to be assigned or referred to an attorney for collection, buyer agrees to pay seller's reasonable collection and/or attorney fee and all court costs.
       The undersigned hereby certifies that he or she is duly authorized to sign this application on behalf of applicant/buyer, that the information given in this application is true and correct to best of his or her knowledge and that the applicant/buyer hereby agrees to the foregoing terms and conditions
Personal Guarantee: In order to obtain credit from Computer Spectrum, Inc.  I hereby guarantee the payment of all debts incurred by the above noted company, even if the invoice is made out to a corporation or partnership.

Date:                                                              Signature: