Red Wing Brands of America, Inc

RED WING BRANDS OF AMERICA, INC.

CREDIT APPLICATION

Region/Rep: ______Brand: ______

Fax: 651/385-1149 Existing Account Number: ______

Company Legal Name: ______DBA/AKA: ______

D & B Number (if available): ______

Bill to Address: ______Ship to Address: ______

City: ______City: ______

State: ______Zip: ______State: ______Zip: ______

Telephone: ______Fax: ______

Email: ______Federal ID/SSN: ______

Type of Business: Sole Proprietorship: ____ Partnership: ____ Corporation: ____ LLC: _____

Name of Owner(s): ______Partners: ______

Home Address: ______City: ______State: _____ Zip: ______

Accounts Payable Contact: ______Telephone: ______

Credit Limit Desired: ______

Anticipated Annual Sales: ______Sales Tax Exemption Certificate Enclosed? _____

Date, Current Store Purchased: ______Year Business Began: ______

Shipping: Best Way_____ UPS Only _____ Priority Mail _____ UPS Collect# ______

FedEx Collect# ______Other Handling Requirements: ______

Vendor Agreement or Routing Guide (please attach) Store Classification: ______

Participation in Central Billing: ______yes ______no

Business References:

Name: ______Name: ______

Address: ______Address: ______

City: ______State: ______Zip: ______City: ______State: ______Zip: ______

Phone: ______Fax: ______Phone: ______Fax: ______

Account Number: ______Account Number: ______

Bank Reference:

Name of Bank: ______Address: ______

City: ______State: ______Zip: ______Contact: ______

Telephone: ______Account Number: ______

The above required information is for the purpose of obtaining credit information and is warranted to be true. I/We hereby authorize Red Wing Brands of America, Inc. to investigate the references listed pertaining to my/our credit and financial responsibility. Further, I/we have reviewed and agree to comply with Red Wing Brands of America, Inc.’s marketing policies as they apply to the distribution of footwear including internet sales, as stated in our catalog or separately. Failure to follow such policies may result in termination of my/our account. My/our signature(s) attests financial responsibility and willingness to pay invoices in accordance with terms offered and agree to pay interest charges at the rate set by Red Wing Brands of America, Inc., which are applied to balances 10 days or more past due. By signing this agreement I/we acknowledge that if my/our account is placed with a collection agency; I/we are responsible for all fees incurred.

The undersigned hereby consent(s) to Red Wing Brands of America, Inc.’s use of a non-business, consumer credit report on the undersigned in order to further evaluate the creditworthiness of the undersigned as principal(s), proprietor(s) and /or guarantor(s) in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorize(s) Red Wing Brands of America, Inc. to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as an individual(s) hereby knowingly consent to the use of such report consistent with the Federal Fair Credit Reporting Act as contained in 15 USC sec.1681 et seq.

Signed by Owner: ______Title: ______

Owner’s Social Security Number: ______

Date: ______

Rev. 01/08/2009