Credit Application Bay Technical Associates, Inc Data Communications Products Division 5239 Avenue A Long Beach Industrial Park, MS 39560 Web Site: baytech.net Fax: 228-563-7336 Phone: 228-563-7335 Toll-Free: 800-523-2702 Please provide all required information. Failure to do so will delay processing. Company Information Co. Name_________________________ Address __________________________ City __________________St.____Zip___ Phone____________________________ Owners/Officer - Names: _________________________________ _________________________________ _________________________________ Accounts Payable Contact: Name: _________________________ Phone: ________________________ Email: _________________________ Company Sales Contact: Name: _________________________ Phone: ________________________ Email: _________________________ BayTech Sales Rep: ________________ Type of Company [] Sole proprietor      [] Partnership [] Corporation (state)_________________ [] Other (specify) ____________________ Year Established __________ No. of employees _______________ Annual Sales________D & B #____ Please include a copy of a current financial statement. Bank Information Name of bank______________________ Address__________________________ City_________________St.___Zip_____ Account #_________________________ Phone_______________Fax__________ Bank Officer_______________________ Trade References (minimum of 3) Note: Do not include TECHDATA, INGRAMMICRO, MERISEL, GE OR AMERITECH.   They do not supply references. 1.Co.Name_________________________ Address ___________________________ City___________________St.____Zip___ Phone_________________Fax_________ Contact(s)__________________________ Email: ____________________________ Account #__________________________ 2.Co.Name_________________________ Address ___________________________ City___________________St.____Zip___ Phone_________________Fax_________ Contact(s)__________________________ Email: ____________________________ Account #__________________________ 3.Co. Name________________________ Address___________________________ City___________________St.____Zip___ Phone_________________Fax_________ Contact(s)__________________________ Email: ____________________________ Account #__________________________ IMPORTANT: I hereby authorize the release of all credit information to Bay Technical Associates, Incorporated. Signature______________________________Title______________Date_______ No credit information will be released regarding the status of your account except through written permission.