Please Fill Out, Print, Sign and Return One Copy.
Company Name	Date
Owner's Name
Address	Type of business:
City/State/Zip	Partnership
Contact Name	Corporation
At Present Location Since (date)	Subsidiary
Phone Number	Sole Proprietor
Fax Number
Federal ID#

In consideration of credit extended, signer agrees to pay for all charges in accordance with terms of the account. In the event suit is necessary to collect this bill, suit may be filed at the Municipal Court in Ventura, CA. Signer agrees to pay reasonable attorney's fees in the enforcement of this agreement.

Signature________________________________

Title

In order to expedite your application for credit, we require trade (publication) references. In the event you have not previously advertised, please list 3 companies you have been doing business with for a minimum of 3 years.
Company Name		Contact Name
Address		Phone Number
City/State/Zip		Fax Number
Company Name		Contact Name
Address		Phone Number
City/State/Zip		Fax Number
Company Name		Contact Name
Address		Phone Number
City/State/Zip		Fax Number
BANK REFERENCE
Bank Name		Phone No.
Address		Account No.
City/State/Zip
799 Camarillo Springs Road • Camarillo, CA 93012-8111 Phone: (805) 445-8881 • Fax: (805) 445-8882