EFTA00521643.pdf

ATTN : Fabricut, Inc. CREDIT APPLICATION FABRICUT' Brand Focus 0 Fabricut O Stroheim O Trend O Vervain O S. Hanis O Fabricut Contract O Export Business Inform.] Gin Business Legal Name Trade Name Subsidiary or Division of Mailing Address City, State Zip Shipping Address City State, Zip Phone Fax E-Mail Company Type: O Corporation, what state O LLC K Proprietorship O Partnership Federal ID No Year Established Preferred Account Terms: O Open, net 30 O COD O CBD (Proforma) Officers. Partners or Sole Proprietors Name Soc. Sec. No With Finn Since 1 2 3 U.S. Trade References Cnmoany Name Phone Number Fax Number Account Numbei 1 2 3. Sales Tax Exemption O RESALE CERTl Fit ATE- We certify that we hold a valid sales tax permit number for the State of We are in the business of wholesaling. retailing, manufacturing or leasing. Our purchases from you of (describe products) are for wholesak or resak or are ingredients or components of a new product to be resold, leased, or rented in the normal count of business. We hither certify that if any property so purchased tax free is used or consumed by us making it subject ton Sales or Use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform you for added billing. This certification shall be a part of each order which we may hereafter give you, unless othenvise specified, and shall le valid until cancelled by win writing or revoked by the city or state. We also agree to reimburse you for any sales tax later determined by Fabricta. Inc. to be due and poyab:e. O EXEMPTION CERTIFICATE. We certify that we are a tax-exempt entity (church, school. goverment agency. etc.) holding exemption certificate number for the State of O NO EXEMPTION CERTIFICATE. We hold no exemption certificate and should be charged all applicable tat Terms and CorditionR We agree that du: standard terms of sale for Fabricut, Inc. are net 30 days from chic of invoice aid that shipments will be held if our account becomes delinquent. All orders are subject to credit approval when received. A service charge of 1 Wie per month will be charged on balances not paid within terns. In the event of default in payment, we agree to pay all collection fees, court costs, attorney fees and interest incurred through collection procedures. We understand that the information included in this application is for the we of Fabricut, inc. in determining the amount and conditions of credit to be extended. We certify that the information is correct. We authorize Fabricut. Inc. or its agents to investigate our credit referents and report our credit performance to the proper persons and credit bureaus. Owner or Officer's Signature Title Date INTERNAL USE ONLY OSample ONSA Sales Rep Date Ter Br Sec O/E FAB - LRS P.O. Box 470490, 'Balsa, OK 74147-0490 FAB-090 803/10 PHONE: 800-999-8200 FAX: 800-888-7171 EFTA00521643