Application for Credit       [FrontPage Save Results Component] Company Name: Billing Information Address: City: State: Zip: County: Contact Name: Phone #: Type of business: Are you tax exempt? yes no If yes, please include the following: Resale # Please attach copy of resale certificate Does your company require a purchase order number? yes no Shipping Information (If different from above) Address: City: State: Zip: County: Contact Name: Phone #: Fax #: Credit References (Please do not list credit cards) 1. phone# fax # 2. phone# fax # 3. phone# fax # Bank Accounts 1. 2. Have you ever declared bankruptcy? yes no Terms of Credit Title: Purchaser agrees that title to the merchandise is reserved by and remains vested in seller until the purchase price is paid in full. If the purchaser shall fail to pay any part of the purchase price when due, seller may take possession of said merchandise without notice or liability to purchaser. In case of collection by suit or otherwise, purchaser agrees to pay all costs, interest until paid, and a reasonable sum for attorney fees. Claims: No claims allowed after 3 days of receipt of goods. No credits will be allowed for goods returned without written authorization. No allowance for damage in transit. Upon receipt, risk of loss, damage and destruction shall be assumed by purchaser. Finance Charge: A monthly service charge of 1.5% is made on overdue accounts. The finance charge is computed by a ‘Periodic Rate’ of !.5% per month (or a minimum charge of 75 cents for balances under $50.00) which is an annual percentage rate of 18% applied to the previous valance without deducting current payments and/or credits appearing on the statement. I have read the terms outlined in this credit application. I personally assume the responsibility of all charges made by the company, for which I am completely responsible. Name: Driver’s License #: Address: