All fields marked with an asterisk (*) are required.

BUSINESS INFORMATION

Legal Name of Business*

Type of Organization*

Tradestyle*

Address*

City*

State*

Zip Code*

Country*

Phone*

Date Established*

State Established In*

Fax Number

Sales Tax Exempt* (If yes, please attach copy of Certificate)

If yes, please attach a copy of the Certificate(File Limit: 4MB)

Business Email*

Federal ID Number*

Contractor`s License Number*


CORPORATE OFFICERS OR LLC MANAGERS

President/LLC Manager

Secretary

Vice-President/LLC Manager

Treasurer


Individual Owner/Partners or LLC Members (Attach additional sheets if necessary)

Individual Owner

Name

Home Address

Social Security Number

Partnership/LLC

Partner/Member Name

Home Address

Social Security Number

Partnership/LLC

Partner/Member Name

Home Address

Social Security Number

Attach Additional Sheets(FIle Limit: 4MB)

Credit Line Requested

Please attach latest annual financial and operating statements, accompanying notes and/or auditor comments to support the application(File Limit: 4MB)

Bank Name

Phone Number

Full Address

Person to Contact

Saving Account Number

Checking Account Number

Loan Account Number


Supplier Credit References (List only those that you have purchased from within the last year)

Name

Street Address

City

State

Zip Code

Fax Number


Name

Street Address

City

State

Zip Code

Fax Number


Name

Street Address

City

State

Zip Code

Fax Number


Additional Bank References

Bank Name

Phone Number

Full Address

Person to contact

Saving Account Number

Checking Account Number

Loan Account Number


Proposed Guarantor(s) to support Credit Line Request

Print Name here

Full Address

Social Security Number


Print Name here

Full Address

Social Security Number


Conditions of Sale, Terms of Payment, Applicant's and/or Co-Applicants's Signature(s).

In consideration for any extensions of credit by Seller, Purchaser agrees to the terms and to the conditions of sale shown on each invoice. Purchaser also agrees to pay late charges at a rate equal to the maximum permissible rate for contracts, or 18 percent per annum, whichever is less, on any unpaid delinquent balance until paid in full. Accrual of late charges shall not affect Seller's right to sue Purchaser for collection of delinquent balances. Purchaser also agrees to pay all Seller's collection expenses, including, without limitation, Seller's actual attorney fees and costs whether or not litigation is commenced against Purchaser, including those incurred prior to and at trial and on any appeal and those incurred in connection with any bankruptcy case or other insolvency proceeding commenced by or against Purchaser or any person granting a security interest to Seller. Purchaser agrees that this agreement is entered into and is governed by the laws of the province set forth in Seller's address. Purchaser hereby affirms that the information contained in this application and in any attachments is true, complete, and correct, and acknowledges that Seller is relying on this information if Seller makes any requested extension of credit. Purchaser agrees to provide updated financial information to Seller upon request and in any case no less frequently than annually.

Seller is authorized to make, and to update as Seller deems necessary, any investigation of the credit and/or employment status of the Purchaser and any person signing below, either directly or through any agency employed by Seller, by obtaining credit reports or otherwise. Seller may disclose to any other interested parties Seller`s credit experience with this credit account. Seller may also keep this application even if it decides not to extend credit. All credit availability decisions with respect to the extension and continuation of credit shall be at the sole discretion of the seller. Seller may terminate credit availability at its discretion without prior notice.

The persons signing below acknowledge that they have read the foregoing and are authorized to sign this application on behalf of Purchaser to evidence Purchaser`s agreement thereto.

Print Name Here*

Title*

Date(mm/dd/yyyy)*

Print Name Here

Title

Date(mm/dd/yyyy)