Confidential Credit Application & Agreement

Date: 07/03/2025

Confidential Credit Application & Agreement

Company Name(Required)

(“the company”) applies for the extension of credit by PRC Industrial Supply and submits the following information as a basis for PRC INDUSTRIAL SUPPLY consideration. PRC INDUSTRIAL SUPPLY IS HEREBY AUTHORIZED TO UNDERTAKE ANY INVERSTIGATIONS OR MAKE ANY CONTACTS NECESSARY TO VERIFY THIS INFORMATION.

Street *(Required)

Mailing *(Required)

City, State & Zip *(Required)

Type of Business *(Required)

Tax Exempt

Yes

No

Sales Tax Exempt no.

Tax Exempt PDF

Accepted file types: pdf, Max. file size: 10 MB.

Established *(Required)

Phone No. *(Required)

Corporation

Email address for Invoices/Statements *(Required)

Principal Owners of Stockholders

Name

Home Address

Street, City & State

Title

Name

Home Address

Street, City & State

Title

Name

Home Address

Street, City & State

Title

Trade References

Name

Home Address

Fax #

Phone #

Name

Home Address

Fax #

Phone #

Name

Home Address

Fax #

Phone #

Name of Bank *(Required)

Address *(Required)

Acct. No.

Phone No.

Acct. Officer

The Company is able to meet its financial commitments and agrees expects to pay PRC INDUSTRIAL SUPPLY invoices according to the terms and contained thereon. Should payment not be made within the specified time the company agrees to pay a finance charge computed at the rate of 1 1/2% per month on all outstanding balances? This is an ANNUAL PERCENTAGE RATE OF 19%. Should the forgoing interest rate be usurious under applicable state law the Company hereby binds itself to pay the maximum rate permitted by law. Should it be necessary to place this acct.

Witness *(Required)

Name of Company *(Required)

By *(Required)

Signature(Required)

Full Name(Required)

2828 Lausat Street
Metairie, LA 70001
(504) 833-8345
Fax (504) 833-8346

5495 East Rite Road
Theodore, AL 36582
(251) 653-4334
Fax (251) 653-4344

930 E. Sam Houston Pkwy. S.
Pasadena, TX 77503
(346) 701-8876
Fax (832) 831-0678