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Safe-Card ID Credit Application

We are looking forward to working with you and your organization. Please print out the following credit application and fax it back "Attn: Credit Department" to 704-535-0703 when complete. Our credit specialists will provide a credit response to you upon their review.

If you have any questions in the meantime, please contact your sales representative toll free at 888-485-4696.

Business Name_____________________________________________________

Authorized Purchasing Agent__________________________________________

Address (street, city, state, zip)________________________________________

Telephone___________________________Fax____________________________

Type of Business: Proprietorship Partnership Corporation Wholesale Retail Distributor Dealer

Principal’s Name_____________________________ Title____________________

Telephone__________________________________

Soc. Sec. No. or EIN No._______________________

Home address (street, city, state, zip)

________________________________________________________________

Bank____________________________________

Contact_________________________________

Address (street, city, state, zip)

________________________________________________________________

Telephone________________________Fax_______________________________

Checking Account Number________________________

Savings Account Number_________________________

References

Company Name___________________________Contact________________________

Address________________________________________________________________

Telephone______________________________Fax_____________________________

Company Name___________________________Contact________________________

Address________________________________________________________________

Telephone______________________________Fax_____________________________

Company Name____________________________Contact_______________________

Address________________________________________________________________

Telephone______________________________Fax_____________________________

Company Name____________________________Contact_______________________

Address________________________________________________________________

Telephone______________________________Fax_____________________________

I hereby certify that the above information is correct and authorize Safe-Card ID to inquire regarding the company listed above for the purposes of granting credit to the above said applying company.

Name________________________________________

Print Name____________________________________

Title_________________________________________

Date_________________________________________