MSC.com Application Corporation Name: ____________________________________________ DBA: _______________________________________________________ Address: _______________________City:_______State: ____Zip: ______ Telephone #_____________________Fax # ________________________ Federal Tax I.D. # _________________Bus. Days & Hours____________ # of Employees ______________Length of Time in Business_______Years Type of Business_______________________________________________ 3 Trade References: Name__________________Contact___________Phone # _____________ Name__________________Contact___________Phone # _____________ Name__________________Contact___________Phone # _____________ Company Bank_______________________ Branch__________________ Address_______________________City________State______Zip______ Type of Business:      Corporation        Partnership     Sole Proprietor  President/Partner:  Owner Information Name: ___________________________ % of ownership______________ Home Address____________________City________State_____Zip______ Telephone #_____________________________How Long_______Years Drivers License # ____________________ S.S. # ____________________ Date of Birth: _______________ Previous Address( If less than 3 years)_____________________________ _____________________________________________________________ Current Equipment Terminal_______________Auto/Batch/Settle________ American Express # _________________Discover #_________________ I the undersigned authorize you and your affiliate and/or agents to check my credit history in order to initiate this application. Merchant Signature______________________Date: ________________ Print Name_____________________________Title: _________________