Application For Credit

Legal Company Name:
Address:
City/State/Zip:
Phone:	Fax:

Type of Organization: _____ Corporation, _____ Partnership, _____ Proprietorship
Description of Business:
Years In Business:	Annual Sales:	No. Employees:
Federal ID#:

Name and Addresses of Principals and Officers
Name:	Title:
Home Address:	Drivers Lic.#:
City/State/Zip:
Home Phone:	S.S.#:
Name:	Title:
Home Address:	Drivers Lic.#:
City/State/Zip:
Home Phone:	S.S. #:

Bank References
Bank Name:	Account #:
Address:	Account #:
City/State/Zip:	Phone:
Bank Name:	Account #:
Address:	Account #:
City/State/Zip:	Phone:

Trade References
Company:	City/State:	Telephone:	Account #:
.	.	.	.
. .	.	.	.
. .	.	.	.
. .	.	.	.

Est.Monthly Purchases:

Requested Credit Line:

The undersigned certifies that all information in this credit application is complete, factual and correct, and understands that the supplier will rely on the accuracy of this information for credit that may be extended. The undersigned certifies that I am authorized to fill out this agreement and sign below for the Company shown above. Supplier is hereby expressly authorized to contact any parties listed herein and to verify any information contained in this application.

Name:	Title:
Signature:	Date:

SysCon Technology, Inc.

31500 Grape St #3-289, Lake Elsinore, CA 92532

E-mail: sales@
syscontech.com

(951) 674-5081 or FAX: (877) 683-1721

Revised 6/30/07