CREDIT APPLICATION - Premio, Inc.

Terms Requested: Line Requested: $
Company Name:
Trading as (DBA):
Address:
City:
County:
Bank Reference:
1.
2.
State: ZIP:
Phone No.: ( ) Fax No.: ( )
Date Business Started:
Parent Company (if any):
Accounts Payable Contact:
A/P Phone No.: ( ) A/P Fax No.: ( )
A/P E-Mail Address:
Web Site Address:
Federal Tax ID No.:
Resale Permit No.:
Dun & Bradstreet No.:
Principal Owner/Officer:
Home Address:
City: State: ZIP:
SSN: Home Phone No.: ( )
Bank: Account No.:
Address:
Phone No.: ( ) Fax No.: ( )
Bank: Account No.:
Address:
4405 Blystone Lane. Plano, TX 75093
Phone : 972.205.0318 Fax : 972.205.0683
CREDIT APPLICATION
Phone No.: ( ) Fax No.: ( )
PO Required: Y N
Date:
Organizational Form
Sole Proprietor
Partnership
LLC
Corporation
C
S
Other:
_________
State of
Incorporated:
_________
Annual Sales Volume
Below $500K
$501K - $1M
$1M - $10M
$10M - $25M
$25M +
Account Type
Authorized Signature: _________________________________________ Date: _____________
Officer’s Name (please print): ___________________________ Officer’s Title: _____________
Page 1 of 4
Sales Rep:
Checking
Savings
LOC
Other _________
Checking
Savings
LOC
Other _________
* Please complete page 4 for authorization to release bank account information (REQUIRED)

Trade References:
Please Provide at least 3 vendors with the most current account standing.
1 Name: Account No.:
Address: City: State: ZIP:
Phone No.: ( ) Fax No.: ( )
Terms: Credit Line:
2 Name: Account No.:
3
4
5
Contact Person:
Contact Person:
Address: City: State: ZIP:
Phone No.: ( ) Fax No.: ( )
Terms: Credit Line:
Name: Account No.:
Contact Person:
Address: City: State: ZIP:
Phone No.: ( ) Fax No.: ( )
Terms: Credit Line:
Name: Account No.:
Contact Person:
Address: City: State: ZIP:
Phone No.: ( ) Fax No.: ( )
Terms: Credit Line:
Name: Account No.:
Contact Person:
4405 Blystone Lane. Plano, TX 75093
Phone : 972.205.0318 Fax : 972.205.0683
CREDIT APPLICATION
Address: City: State: ZIP:
Phone No.: ( ) Fax No.: ( )
Terms: Credit Line:
* We request that you provide your most updated references for the periodic credit reviews.
Authorized Signature: _________________________________________ Date: ___________________
Officer’s Name (please print): ______________________________Officer’s Title: ________________
Please enclose a copy of your company’s current year-end and interim financial statements.
Page 2 of 4

1.
2.
3.
4.
5.
4405 Blystone Lane. Plano, TX 75093
Phone : 972.205.0318 Fax : 972.205.0683
CREDIT APPLICATION
SECURITY AGREEMENT AND MASTER SALES AGREEMENT
Buyer agrees that Premio, Inc. (Seller) will maintain a security interest in all goods sold and delivered.
Buyer will advise Seller on demand as to the location of all goods in his possession. Buyer will execute on demand
a UCC-1 or similar financing statement to perfect Seller’s rights in the goods. If Buyer fails to execute such a document,
Seller may do so and sign Buyer’s name. Buyer irrevocably appoints seller as his attorney in fact to place said
signature on the document and record it with appropriate authorities.
If buyer fails to pay as agreed or otherwise defaults, Seller may repossess the goods, and may enter onto private
property to do so, and may enter any structure to do so. Buyer is obligated to assemble the goods. If the goods are
repossessed, Seller may exercise all rights of the State’s Commercial Code or the similar statutes in any state where
the goods are taken. Upon repossession, the Seller may sell without notice and at private sale, to the greatest extent
allowed by law, and may sell in any commercially reasonable manner.
Seller has all rights under law. All rights are cumulative. If Seller has to go to court to enforce this agreement, the
prevailing party shall recover reasonable attorney’s fees. Suit can only be brought in the appropriate county or state
court. This Agreement is governed by state law.
Buyer will not assign or pledge the goods until payment is made in full. Any such assignment or pledge shall be void.
The terms and conditions of this Agreement apply to all sales made between the parties. The price, terms of payment,
delivery information, and all matters including warranty information places on the front or reverse of the invoice
delivered by Seller in connection with the sale shall be the terms of sale. If no payment terms are specified, then
the terms of payment are prepay. Time is of the essence. The terms of Seller’s invoice and this Agreement shall take
precedence over anything in Buyer’s Purchase Order.
I/We agree to the above and state that all information in the credit application is true, and Premio, Inc.
has the right to check all credit sources, and the credit of any guarantors. If any information is false, then Seller
can declare all sums due and owing and exercise any rights to security.
______________________________ ______________________________ _____________
COMPANY SIGNATURE AND TITLE DATE
__________________________________________________________________________________________________
Personal Guarantee: For valuable consideration, I personally guarantee the payment of all Premio, Inc. invoices
and full performance by my company. Premio, Inc. can compromise or settle with my company and still require
me to pay. I waive all defenses of surety law and agree to be primarily liable for all payments, including reasonable attorney’s
fees. I waive notice of dishonor, presentment and protest. This is a continuing guarantee which can only be terminated by
written notice, and then only as to sales occurring after delivery of such notice.
_____________________________________ _____________________________________
PRINT NAME SIGNATURE
Page 3 of 4

BANK CREDIT REFERENCE
To: Bank: __________________________ Account No.’s: __________________________
Address:
_________________________ Checking: __________________________
__________________________ __________________________
__________________________ Savings: __________________________
Phone: __________________________ LOC: __________________________
Dear Bank Officer:
4405 Blystone Lane. Plano, TX 75093
Phone : 972.205.0318 Fax : 972.205.0683
Fax: __________________________ Other: __________________________
I authorize you to release information about our account standing, credit line, and payment history to
Premio, Inc. to be used explicitly for the establishment of an open account credit line and annual credit
reviews. This information is to be kept within the strictest of confidence.
Signed: ______________________________ Officer’s Name: ___________________________
Page 4 of 4
Officer’s Title: ____________________________
Company: ____________________________
____________________________
____________________________
* If bank charges a fee to provide account information, then we accept summary page
of your most recent 3 months bank statement.