Company Name
Shipping Address
Shipping City
Shipping State
Shipping Zip Code
Billing Address
Billing City
Billing State
Billing Zip Code
Company Phone
Company Fax
Email

Name of Principals	Position

Type of Business	Corporation   Proprietorship   Partnership
Date Business Started
Resale Certificate
County/Sales Tax Rate

Suppliers Names	Phone	Fax

Bank
Account Number
Address
Phone
Fax

If any legal action is brought to collect money for goods or merchandise sold pursuant to this credit application, Yates & Felts, Inc. shall be entitled to recover reasonable attorney's fees from the party listed above. These may be set by the court in the same action or in separate action brought for that purpose and are in addition to any other relief to which Yates & Felts, Inc. may be entitled.