Company: Fed. ID/SS#
  Address: Type of Business: Sole Owner
       
Partnership
  City/ST/Zip:   Corporation
         
  Phone # Mobile#
         
  Nature of Business: Time in Business:
         
  Company Contact: Title:
         
  Bank Name: Account:
         
  Phone#’s Bank Contact:
         

Credit References:
         
  Name: Name:
         
  Address: Address:
         
  City/ST/Zip: City/ST/Zip:
         
  Phone: Phone:
         
         
  Name: Name:
         
  Address: Address:
         
  City/ST/Zip: City/ST/Zip:
  Phone: Phone:
The undersigned represents that he/she is an authorized agent of the above company, that all information provided is accurate and true, and Lone Star is authorized to contact the above named references to determine the credit worthiness of the applicant. The applicant and the undersigned guarantee payment according to the terms awarded for all amounts owed to Lone Star and to pay all sums to seller at it’s address in Travis County, Texas. Such county being agreed upon as the county of venue for any suit brought by either party hereto against each other. Lone Star Supplies reserves the right to suspend or revoke credit for past due accounts.

  Authorized Signature:

  Title:
  Date:
 
Ph 512-280-5145
Fax 512-280-2504
www.lonestarsupplies.com