Application for New Account

Please submit the following information. All information provided to us will be held strictly confidential.

Business Name: ______D.B.A.: ______Contact: ______

Email address: ______Website: ______

Address: ______City: ______State: ______

Zip code: ______Phone: ______Fax:______

__ Corporation / S-Corp __Limited __ Proprietorship __ Partnership __ LLC ____Years in Business

Federal Tax ID #______Resale Permit# ______SSN: ______

Has the business or any of its principals ever declared bankruptcy? ______Yes ______No

Bank References:

Name______Fax #______Tel. # ______

Address ______City: ______State: _____ Account Number______

Name______Fax #______Tel. # ______

Address ______City: ______State: _____ Account Number______

Trade References

Name______Fax #______Tel. # ______

Address ______City: ______State: _____ Account Number______

Name______Fax #______Tel. # ______

Address ______City: ______State: _____ Account Number______

The Applicant authorizes the company to contact the financial, bank and trade references (including those listed herein) and any credit reporting agencies to obtain/verify credit information;

· promises to pay my/our account in full on or before the due date as defined on the invoice;

· agrees to pay any and all services charges assessed at the rate of 3% per month on past due balances;

· agrees to pay all of the costs and expenses, including but not limited to, third party collection agency fees, attorney’s fees, legal expenses, and/or other fees or expenses incurred enforcing any terms of this agreement collecting amounts owed by applicant;

· agrees to notify the Company in writing prior to any changes in ownership, billing address, or authorized buyers;

· agrees that if any term of this agreement is invalid the invalid term shall be considered deleted from the agreement and shall not invalidate any other term(s);

· that venue and jurisdiction of any suit or legal action will be in West Sacramento, Sacramento, California;

· that this information has been submitted with the knowledge that it will be used in evaluation the creditworthiness of the applicant for obtaining credit or extending additional credit; and

· that the above information is warranted to be true and correct to be the best of applicant’s knowledge.

My/Our signature(s) below serve(s) as written consent for the company to access personal credit history and/or business credit information for the purpose of determining my/our credit standing in conjunction with opening a business credit account. The undersigned further aggress that he/she is an authorized agent on behalf of the applicant and authorized to affix their signature to this agreement.

PLEASE INCLUDE A COPY OF SELLER’S PERMIT or YOUR CERTIFICATE OF REGISTRATION (SALES TAX).

______

Signature

Print Name / Position Date