Netceed Credit Application

The Undersigned Company is applying for credit with Walker & Associates, Inc., Comstar Supply, Inc. and Multicom, Inc. (hereinafter collectively referred to as "Netceed", or individually as "Netceed Company") and agrees to abide by the standard terms and conditions of each Netceed Company, as applicable.

Company Information

This should be empty:

Legal Entity Name *		DBA (if applicable)
Physical Address *
City *	State *		Zip *
Web Address

Email Invoice *
Email Address
Bill to Address *
Bill to City *	Bill to State *		Zip *

A/P First Name *	A/P Last Name *
A/P Phone *	A/P Email *
Federal Tax ID *	DUNS Number
Business Established *	Number of Employees
Nature of Business	Number of Locations
Publicly Traded	Stock Symbol

Prior Bankruptcy	Discharge Date		Chapter Filed
Incorporated	State of Incorporation		Business Type

Are you a Subsidiary, Division or Affiliate of another company? Yes No

Owners / Partners / Officers

First Name *	Last Name *	Position *
Phone *	Email Address

First Name	Last Name	Position
Phone	Email Address

First Name	Last Name	Position
Phone	Email Address

Authorized Purchaser(s)

First Name *	Last Name *	P.O. Required *

First Name	Last Name

Bank Reference

Institution Name *		Routing Number *
Account Number *	Account Type *	Account Balance
Contact Name *	Phone *	Credit Limit Desired *
Address *
City *	State *	Zip *

Trade References

Company Name *		Phone *
Address *		Fax
City *	State *	Zip *
Contact *	Account # *
Email

Company Name *		Phone *
Address *		Fax
City *	State *	Zip *
Contact *	Account # *
Email

Company Name *		Phone *
Address *		Fax
City *	State *	Zip *
Contact *	Account # *
Email

Taxes

Tax Exempt *

Please provide documentation for all states in which your company is tax exempt. Until such documentation is received, taxes will be charged for all states in which Walker is registered.

Upload Tax Certificates:

Choose files or drag them here.

Transmitting Documents:
By Email:
By Fax: 336-731-3089

Signature

Authorized Signature *	Name of Owner, Officer, or Principal	Title *
A typed signature warrants that the information given above, and related financial disclosures, are true and accurate.

By submitting this application, you agree to our terms and conditions of the sale and authorize Walker & Associates Inc. to make inquiries into your banking and business/trade references.

Parent Name *
Parent Address *
City *	State *	Zip *
Parent Type *