Memory Source, Inc. Credit Application
800 Roosevelt Rd Bldg B 
Glen Ellyn, Il 60137
ph. 800-260-3167
fax 630-942-0852

Company Name:________________________________________________

Address:_______________________________________________________

City:______________________  State:_____  Zip:______________________

Phone:_________________________ Fax:_____________________________

Year Business Started:_________ Owner's Name:_______________________

Bank Name and Account #:__________________________________________

Bank Contact and Phone #: _________________________________________

Resellers #:________________________________________________________

Major Trade References/Supplier Name Account # Phone #

1._________________________________________________________________

2._________________________________________________________________

3._________________________________________________________________

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By returning this application to Memory Source, Inc., I (we) authorize Memory Source

to obtain information from credit reporting agencies and our vendors, suppliers and

financial institutions. All information will remain confidential. A $20 service charge will

be assessed on all returned checks. All past due accounts will be charged a 1.5%

per month service charge on the outstanding balance. I (we) have a valid resellers #

and intend to resell all merchandise purchased from Memory Source, Inc.

INDIVIDUAL GUARANTEE: I (we) the undersigned, in consideration of Memory

Source, Inc. opening an account with or extending credit to the above named business

pursuant to this application of my (our) request as an officer, director, owner, stock

holder of company, hereby personally (and jointly and severally, if more than one)

guarantee payment of debts and all legal and other costs of collection incurred in

collection with the aforesaid credit.

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Date                                   Signature                                       Name (printed)