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APPLICATION FOR CREDIT
Thank you for your interest in Newport Corporation. To assist us in your request for credit, please thoroughly complete this application, sign where indicated, and provide ALL information.
Legal Business Name DBA
Bill To Address Ship To Address
City, State & Zip City, State & Zip
Telephone A/P Contact
Facsimile Email Address
State of Inc.  
Nature of Business: (Please check one)


Date Business Started: Number of Employees:
Federal Tax ID#: Parent Company:
Dun & Bradstreet#:
Information on Principals: Credit Limit Requested :
For Sole Proprietor or Partnership: List all Owners and/or Partners.
For Corporation or Limited Liability: List all Officers, Directors, Members and Majority Stockholders.
Name Title Home Address Phone Social Sec No.
CREDIT REFERENCES:(Attach separate schedule if necessary)
Primary Bank: Secondary Bank:
 Bank Name:  Bank Name:
 Address:  Address:
 City, State & Zip:  City, State & Zip:
 Bank Contact:  Bank Contact:
 Telephone:  Telephone:
 Facsimile:  Facsimile:
 Checking A/C#:  Checking A/C#:
 Savings A/C#:  Savings A/C#:
 Loan A/C#:  Loan A/C#:
 Line of Credit: Available: 
Balance: 
 Line of Credit: Available: 
Balance: 
Largest Suppliers: (Please do not list subcontractors, revolving credit accounts, or utilities)
 Name:  Contact Person:
 Address:  City, State & Zip:
 Telephone:  Facsimile:
 Account#:
 Name:  Contact Person:
 Address:  City, State & Zip:
 Telephone:  Facsimile:
 Account#:
 Name:  Contact Person:
 Address:  City, State & Zip:
 Telephone:  Facsimile:
 Account#:
Upon request will you furnish current financial statements?
Does your organization export product out of the country?
If exempt from sales tax? (Complete attached exemption certificate)
FOR THE PURPOSE OF OBTAINING MERCHANDISE FROM SELLER ON CREDIT, THE ABOVE STATEMENT IN WRITING IS MADE, INTENDING THAT SELLER SHOULD RELY ON THE SAME AS CORRECT. BUYER FURTHER AGREES TO THE TERMS AND CONDITIONS AS SET FORTH HEREINBELOW.
As consideration for the advancement of credit, he undersigned agree as follows:
1. To be bound by all of the terms and conditions contained in this application.
2. Seller may, at any time, without notice, cancel all credit available to Buyer and refuse to make any further credit advances. In the event Seller determines that information contained on this Credit Application is false or misleading, or if Seller receives other false or misleading credit information from Buyer of any kind or nature, Seller may without further notice cancel any orders in house, or any deliveries in progress to Buyer. Any false or misleading information by Buyer shall be construed as a material default, and any invoices outstanding shall be immediately due and payable in full.
3. To pay all costs and attorney's fees incurred by Seller in relation to the interpretation or enforcement of any or all of our obligations hereunder, whether or not suit is filed.
4. That this agreement has been entered into and is to be performed in the County of Orange, State of California, and any action brought hereunder shall be brought in the federal or state courts located in said county and state.
5. The undersigned warrants and represents to Seller that the business entity we represent is solvent and is able to pay our obligations as they become due. The business entity we represent will not place any order with Seller unless it reasonably believes that it will be solvent and able to pay its obligations as they become due at the expected time of shipment.
6. That the Seller may use this agreement with any bank or other kind of financial institution for the purpose of obtaining all personal and business financial information of any kind or nature in the name of us, and/or the entity we represent.
Signature:  Date: 
Print Name:  Title: 

STATE:
CERTIFICATE OF EXEMPTION
NAME:
ADDRESS:
I hereby certify: that I hold a valid seller's permit No.:
issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling:
 ;
that the tangible personal property described herein, which I shall purchase from:
NEWPORT CORPORATION
will be used by me in the form of tangible personal property; provided, however, that in the event any such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount.
Description of property to be purchased (please check one):


Date: Printed Name of Purchaser:
Phone No.: Signature & Title:

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