Brandt Services, Inc BSI Batteries

2326 Centerline Ind. Dr. Saint Louis, Missouri. 63146

(314)567-1567 (314)567-4153 Fax www.brandtservicesinc.com

________________________________________________________________

Business Credit Application

Customer Name

Street

City State Zip

Phone# Fax#

Federal ID#

If Tax Exempts : Tax ID#

Check One:( ) Corporation-Date of Incorporation

State of Incorporation

( ) Partnership-Date Started

( ) Subsidiary Or ( ) Division of

( ) Self-Employeed

SSN

( ) Other - Specify

How long in business

Spouses Name (if not incorporated) SSN

Trade References

Name Name

Address Address

Phone # Phone #

Fax Fax

Name Name

Address Address

Phone # Phone #

Fax Fax

Bank Refferences We must have account numbers

Name Name

Address Address

Phone # Phone #

Account # Account #

I find this credit application to be correct and in the event that this account is not paid and is referred to an attorney for collections, I understandthe above complany is to pay not only reasonable attorney bees and cost of collections but also court costs.

Signature

Print/Type Name

Title

Date