Pacific Design Specialist, Inc. - Serving the Electronics Industry since 1993

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* Please print and fax


FIRM NAME:_________________________________________________DATE:____________________________


Description of business:____________________________________________________________________________


State:__________Zip Code:_______________ Phone:________________________Fax:________________________


President:_____________________________________Vice President:_____________________________________


Direct all accounting matters to:__________________________________Title:______________________________


REFERENCES:(List major suppliers and amount owed or attach a separate credit reference sheet)

Name: Address: Phone: Current Balance:


Bank Name and Official:____________________________________Phone:___________________________________

Bank Address:___________________________________Account No.:____________________________________

Terms: 2%-10Days, Net 30

In consideration of the granting and extension of credit by Seller to the undersigned, it is hereby agreed that the undersigned will promptly pay all sums when due. In the event of non-payment, the undersigned does hereby agree to pay in addition to the principal amounts due, all collection charges incurred by Seller. The undersigned further agrees to pay interest at the rate of 1 1/2% per month (18% per annum) commencing the day following the due date .



__________________________________________COMPANY OFFICER________________________________
Print or Type Name



Pacific Design Specialists, Inc.
San Diego, California
858/450-1672 | Fax: 858/450-0414
printedcircuit005 Credit Application