Advance Companies

1400 Jackson Street St. Paul, MN 55117

651-489-8881 651-489-9416 fax

Please return this credit application to Advance. Applications require up to 3 days for processing.

Name ____________________________________ Phone ( )______________Fax ( )____________

Address _______________________________________________________________________________

City___________________________________________________ State _________ Zip_______________

Type of business __________________________________ Individual ___ Partnership ___ Corporation___

Name of owners and addresses______________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Name of Officers ___________________________________, ____________________________________, ________________________________________, ________________________________________.

How long in business ________Former address if any __________________________________________

Have you ever done business with our company? _____ if so, when ___________

Under what name __________________________________________________

Financial statement enclosed - company _____________________ personal _____________________

If individual or partnership - Social Security #_____________Drivers License #___________ State_____

Bank References:

Name of bank ________________________________ Phone no. ( ) _________________________

Checking acct.# ______________________________ Savings acct.# ______________________________

Loan _______________________________________ Bank contact _______________________________

Credit references:

Name Address Phone Fax

__________________________ ______________________________ ______________ ____________ __________________________ ______________________________ ______________ ____________ __________________________ ______________________________ ______________ ____________ __________________________ ______________________________ ______________ ____________

Accounts payable contact

I (we) promise to pay for all monthly purchases/leases when due (30 days from invoice date)

I (we) assume responsibility for all purchases contracted in the above name and address.

I (we) agree to pay 1 1/2% per month service charge, or the highest allowable rate, whichever is greater, on all amounts outstanding over 30 days.

Signature (must be signed by owner or officer)

Title ___________________________________________ Date ________________________________

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Approved: __________ Date _______________________ Initials __________________________

Account Number _________________________________ Credit Limit ________________________