COMPANY INFORMATION:

COMPANY INFORMATION (CONT.):

BILLING INFORMATION (IF DIFFERENT):

BUSINESS PRINCIPALS:

SALES TAX EXEMPTION:

BANK REFERENCE:

AGREEMENT:

Your electronic signature below is accepted by the parties as authorization for us to contact the bank and any trade references. Minimum initial order for open account is $100. TERMS are NET 30 DAYS. Finance charge of 1.5% per month on all past due balances. Should the account be placed for collection, ALL legal fees, court costs, & any associated cost of collection plus interest@ 1.5% per mo. will be paid by applicant.

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