Datasheet

117
Credit Application
Mail to: Steren Electronics International, LLC.
Attention: New Accounts
6260 Sequence Drive, Suite 110
San Diego, California 92121
Tel [phone]
FAX [phone]
This information is for the exclusive use of our Credit Department and will be held in the strictest of confidence.
Your current year–end financial statement (balance sheet and income statement) must accompany this application if the
credit line desired exceeds $5000. Unaudited financial statements must be signed and dated by the respective owner or
officer. Please indicate what period is covered by each statement.
California customers exempt from sales tax must submit a signed resale certificate.
Business Legal Name
Business Trade Name (dba) or Previous Name Tax I.D. No.
Street Address (required) P.O. Box
City State Zip
Telephone FAX
Description of Primary Business
Number of Employees
Credit Line Desired Annual Sales Volume
Legal Structure of the Business
q Proprietorship q Partnership q Corporation
State in which chartered Year Business Established
Length of time at the above address
q Own q Lease
Number of branches/outlets Square Footage
Have you ever filed for bankruptcy ? q No q Personal qBusiness
Date Filed Current Status
Corporate Officers or Principal Owners
Name Title Telephone
Name Title Telephone
Name Title Telephone
Authorization to Run Credit
q Yes
By Checking Yes you are giving Steren Electronics International LLC. permission to check your credit report.
You MUST check the box before we can process your application.
Name Name
Home Street Address Home Street Address
City/State/Zip City/State/Zip
Telephone Telephone
Social Security No. Social Security No.
Driver Licence No. Driver Licence No.
Please complete both sides
Important Information
General Information
Business Profile
Personal Credit Information