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5711 Etheridge Street Houston, TX 77087

www.nssihouston.com


Customer Name and Address:

Accounts Payable Address:
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Type of Ownership:
If not a corporation, name principal owners:
If wholly owned subsidiary, name of parent company:
Amount of credit line requested $
Company purchase order required?:

BANK REFERENCES

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BUSINESS REFERENCES

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Name:
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If credit is approved, payment terms are net invoice amount due and payable upon receipt of invoices and if not paid in thirty (30) from date of invoice may result in customer being placed on C.OD. NSSI/Sources & Services, Inc. reserves the right to limit the amount of credit extended to each customer. Regardless of payment terms, when this credit limit has been reached, deliveries to and business with NSSI/Sources & Services, Inc. must be on a C.O.D. basis. To avoid delays be sure your credit with NSSI/Sources & Services, Inc. is approved before attempting to schedule any shipment(s). Information provided on this application will be held in the strictest of confidence and will only be used by NSSI/Sources & Services, Inc. for making a credit evaluation. I/We certify all the information on this form is correct to the best of my/our knowledge. I/We fully understand credit terms and agree to proper and timely payment of all invoices, in consideration for regular credit terms.

Name of Company
Date
Title
Authorized Signature


Mail Credit Application to: NSSI/Sources & Services, Inc., 5711 Etheridge Street Houston, TX 77087, or fax to (713) 641-0392


Note:

STATE LAW MAY FORBID THE DISCLOSURE OF FINANCIAL AND/OR CREDIT INFORMATION BY A FIRM WITHOUT THE WRITTEN CONSENT OF ITS CUSTOMER, THEREFORE, THE FOLLOWING WRITTEN AND SIGNED CONSENT IS PROVIDED.

I/We the undersigned hereby request and authorize release and disclosure of any and all pertinent financial and/or credit information by all references listed on credit application to and requested by NSSI/Sources & Services, Inc. 5711 Etheridge Street Houston, TX 77087 Houston, TX 77234 for evaluation and consideration for extension of credit to the undersigned. In consideration for releasing and disclosing requested financial and/or credit information to NSSI/Sources & Services, Inc., I/We the undersigned hold from harm and liability any bank, firm, company and/or individual listed on credit application.


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