Company Name
Date	ex. 03/04/06
Street Address 1
Street Address 2
City
State	Zip Code
Phone	ex. xxx-xxx-xxxx
Owner Name
Email Address
ResaleTax #
FEIN
Bank Name
Branch
Acct #

Date Business Began	ex. 03/04/06
Business Reference 1
Address
City	State
Phone
Business Reference 2
Address
City	State
Phone
Business Reference 3
Address
City	State
Phone

          Type of Organization:CorporationPartnershipSole Proprietorship

            All information is true and accurate to the best of my knowledge.

Electronic Signature Title Date

                                                                                      PERSONAL GUARANTY

The undersigned jointly, severally and unconditionally guaranty the payment of all invoices/statements when due.

Electronic Signature Date

ATCO does not authorize, verify or extend credit. This form may or may not be all that is required by its Clients in the way of an application for credit. Its main purpose is to simplify and expedite the application process. Information will be held in the strictest confidence and will not be sold or otherwise released to unauthorized companies or parties. This form authorizes references to release credit information. All purchases made in one month are due net on the 10th day of the following month. Should it become necessary to place this account with an attorney for collection, suit or other legal action, I/we hereby agree to pay all costs of such collections, suit or other legal action, including a reasonable attorney's fee.

PO Box 2412   Lakeland, FL 33806-2412   863-603-9595   866-245-2826   Fax 863-603-9696