Business Account
Credit Application
Optimus, Inc.
3765 Winchester Rd
Memphis, TN 38118
901-365-1269
Please Fax Completed Form to 901-794-9790
 Date:______________
Business Name___________________________________ Business Phone_______________
Billing Adress_________________________________________________________________
City, State, Zip________________________________________________________________
Shipping Address____________________________If you have multiple ship-to's list on pg. 2
City, State, Zip ________________________________________________________________
Check if this address is a residence Phone No. ______________ Fax No._____________
Check one:
Individual
Partnership
Corporation
Under State Laws______
Owners__________________ Buyer's Name__________________ Year Opened________
REFERENCES:
Name
Phone
Fax
Bank__________________________________________________________________________
Account No.___________________________________
Trade References: Name Phone Fax
1._____________________________________________________________________________
2._____________________________________________________________________________
3._____________________________________________________________________________
Optimus is a repair parts wholesaler selling exclusively to retail/repair/ service companies, who are actively peforming in the swimming pool/spa business. It is not possible for such companies to suceed in buying only from us. You must utilize another supplier for whole goods.
List one suppplier____________________City _________________ Phone ______________
Otherwise submit a business license indicating you are in the pool business, or a voided check, a business card, or some other proof that you are in the trade.
Estimated Monthly Credit Requirements $_______________________
Sales Tax Status: We are Taxable Exempt State No.________________ (include certificate)
Varies by Purchase Order Other (Please Indicate)_______________________________
Be assured that the above information will be held in strictest confidence, and will be used soley for the purpose of establishing an open account on your firm. The above information as well that given on page two is for the purpose of obtaining credit and is warranted to be true. I hereby authorize the firm to whom this application is made to investigate the references listed pertaing to my/our credit and financial responsibility.
Authorized Signature_____________________ Title_________________________________

For any request over $1000, attach finnancial statement and sign guarentee on pg. 2.
Our Terms on approved accounts: Net 10 Days