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�Te%Pacific <br /> reMNa� t�rc a rraro� <br /> i Application for Credit <br /> Please complete ali sections completely and legibly. Incomplete appiications can not be processed. <br /> The information below is warranted to be true and correct by the below named Customer and is given for the purpose of obtaining creJit from TelePacilic <br /> Customer authorizes TelePacific[o conduct a routine credit check in conoection with its appiication for service.TelePacific will keep such infortnation confidential <br /> and only use it for the purpose of evaluating Customer's credit in connection with Customers application for service.This application for credit shall be construed <br /> in accordance�vith the la�vs of the 3tate of Califomia. <br /> Section 1 Customer Information(please compiete all sections completely and legibly) <br /> Company Legal Name(Customer) City Of f22dWOOC� Clty <br /> Doing Business As(DBA) <br /> Legal Composition: Cotporation Sole Proprietorship General Partnership LLP LLC State Organized: <br /> Federai Tax I.D. Exempt?(circle} N� Business Type: <br /> State Tax Info:Tax Exempt# Dun&Bradstreet#(D8B) <br /> Process as Personal Guarantee (Mark if Applicabie) <br /> Officer/Owner Name&Title Social Security# _ _ __ <br /> OfficedOwner Name 8�Title Sociai Security# <br /> Current Carrier Reference:Carrier Name __ _ <br /> Accou�t#: Phone#: Length of Service: <br /> Estimated Monthly Long Distance Usage Estimated Intemationai Usa e International Block? NO <br /> _.._--._......------. 9 ___.._._.______._ <br /> nnain seNi�e Add�ess: 1017 Middle�eld Rd <br /> . _. _ _ ____ <br /> _ _ - ___ __ 94063 <br /> c;ty Redwood City scace CA ZIP Code <br /> Billing Address(if different): <br /> City State ZIP Code <br /> °..�' Zg� �S <br /> --_ --- --_.._ , --_ __ __ . _ _ _ . _------------ <br /> Agreed omer Signature Date <br /> ____ __. ___.. _ __ . _ __ .. _ <br /> Customer Name(Print) Title <br /> �;1�-,-� C��.o _ _ _ _ _ g����1'���"3 _ <br /> Sales Represehtative Name Phone <br /> v 120409 <br /> ATTY/AGR.2015.186Relepacific Telephone Lines <br />