Full legal business name:  Telephone:
Street address:Fax:
City:
State:
Zip/postal code:
Type of business: Corporation Partnership Sole Proprietor Nature of business: Other LLC LLP
  If sole proprietor or partnership list name(s) & SSN(s):
Years in business:
Other names you have done business under:
List officers' names, addresses, phone numbers, and SOCIAL SECURITY numbers:
President: Vice President:
Secretary: Treasurer:

Business Bank: Branch:
Telephone: Checking Account number:
Loan Officer:
Personal Bank (checking): Branch:
Telephone: Checking Account number:
Personal Bank (savings): Branch:
Telephone:Savings Account number:
Have you or any other owner, officer, or partner ever:
  Done business with Miller's Interiors Inc. before? No Yes
    If yes, under what name:
  Declared personal bankruptcy or been an owner/officer of a company which declared bankruptcy or sought the protection of the Bankruptcy Code? No Yes
    If yes, when, where, & under what name:
Does your company:
  Have any past due accounts payable: No Yes
  Have any unpaid taxes, Employment Security, or Labor & Industries: No Yes
  Have any notes or other indebtedness past due or past maturity: No Yes
  Have any lawsuits pending or judgments unpaid: No Yes
    If yes to any of the above, provide complete list of debtors & amounts
        Details: Mailed via USPS (or other) under separate cover E-mailed under separate cover Attached on separate page
Business financial statement: Mailed via USPS (or other) under separate cover E-mailed under separate cover Attached on separate page
Personal financial statement: Mailed via USPS (or other) under separate cover E-mailed under separate cover Attached on separate page
Last year for which federal income taxes were filed:
Amount of monthly credit requested from Miller's Interiors:
Trade references:
  Supplier:City:
    Telephone:Fax:
  Supplier:City:
    Telephone:Fax:
  Supplier:City:
    Telephone:Fax:
  Supplier:City:
    Telephone:Fax:
  Supplier:City:
    Telephone:Fax:
  Supplier:City:
    Telephone:Fax:
I/we certify the above to be a true and accurate statement of my/our financial position and submit same to Miller's Interiors as an inducement to grant me/us credit for the purchase of materials/labor as stated on each Proposal/Contract.


Buyer agrees to pay within the time stated and SIGNATORE ACCEPTS PERSONAL RESPONSIBILITY FOR PAYMENT.
In the event that payment Is not made on these terms and conditions and it becomes necessary for Miller's Interiors to place this claim with an attorney for collection or if In the event of litigation an attorney shall be employed at any stage to enforce Miller's interiors' rights, buyer agrees to pay all reasonable attorney's fees and costs to Miller's Interiors, Inc. At the option of Miller's interiors, Inc., the venue of any suit brought to collect this account may be had In King County Superior Court of the state of the State of Washington.
Payment: Payments to Miller's will be (I) C.O.D., or (II) E.O.M. 1 0 days with credit approval. If payment Is not made when due - charge of 5% will be added to the balance and default Interest of 1-1/2% per month, not to exceed the rate permitted by law, charged on sums owing.
The applicant understands that Miller's will investigate their credit and hereby grants authorization for their bank and other agencies to release Information necessary for extending credit. It is also understood by applicant that this credit application does not obligate Miller's in any way to extend credit to applicant.

Authorized signature:
Date (mm/dd/yyyy):

Authorized signature:
Date (mm/dd/yyyy):