4755 Technology Way, Suite 107 Boca Raton FL 33431

Channel Seafoods Int’l

P: 561-994-3400 F: 561-994-3408

CREDIT APPLICATION

Company ______Phone ______

Address ______Fax ______

City ______State ______Zip Code ______

Year Established ______No of Employees ______Annual Sales ______

Names of Principles/Officers

Name ______Title______

Type of Business □ Corporation □ Individual/Sole Proprietor □ LLC □ Partnership

□ Other ______

Credit References from Seafood Industry

1. Company Name ______Contact ______

Address ______Phone ______City ______State ______Zip Code ______Fax ______

2. Company Name ______Contact ______

Address ______Phone ______City ______State ______Zip Code ______Fax ______

3. Company Name ______Contact ______

Address ______Phone ______City ______State ______Zip Code ______Fax ______

4. Company Name ______Contact ______

Address ______Phone ______City ______State ______Zip Code ______Fax ______

I certify that the above information is correct and hereby authorize you to conduct a credit investigation on our Company.

Signature ______Date ______

Printed ______Title ______

Banking References:

Bank Name______

Contact Name ______

Bank Address______

Direct Phone Line: ______Fax Line: ______

Email: ______

I certify that the above information is correct and hereby authorize you to conduct a credit investigation on our Company.

Amount of Credit Requested $ Credit Terms: 7days 14 days 21 days 30 days

APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY,

ABILITY AND WILLINGNESS TO PAY IN ACCORDANCE WITH ABOVE TERMS:

Firm Name

By: Title:

**PERSONAL GUARANTEE**

For valuable consideration, the receipt of which is acknowledged, including but not limited to the extension of credit by Channel Seafoods Company to

(customer), the undersigned Guarantors, and each of them (if more than one), hereby jointly and severally, absolutely and unconditionally guaranty payment, immediately when due, of any and all liabilities and indebtedness now owing or which may hereafter be owing or become due from the Customer to Channel Seafoods including all interest, costs, charges and actual attorney fees. This shall be a continuing Guaranty.

Signature of Owner/Officer Date

Please fax the completed form to (561) 994-3408 and Email the original to