EFTA00562727.pdf

Sales Order New York Design Center 200 Lexington Avenue, Suite 511 New York, NY 10016 Tel: 212.287.0063 Fax: 212.287.0066 Email: paleceknyOpalecek.com Bill To: Acct e: NYL0002384 Ian 301 EAST 66Th STREET, 14G NEW YORK, NY 10065 Phone: (917) .85-5.33 Fax: Contact Customer PO # Ship Not Before Cancel Iltititititititititi 6 29 2011 ASAP Mfg: PALECEK-BASKETS/ACCESSC Order #: Order Date: 6/29/2011 Order Status: OUOTEMOTE Printed: 6.)282011 2:04:18 PM Ship To: Acct ft: NYL0001184 TBD Please provide ship-to phone rim. I. -Adana ft-,• "III I 1/4_71 PaAW sc i I P \ 1°C(4°5 V9- 3 74. g15. Ship Via Cheapest'Best Source QRLabel64 Terms Promo B/O Sub Assigned Written By TO BE DETERMINED Yes No Your Local Sales ReMeSentatNe PALECEK NEW YORK SHOWROOM Comments lead time: 3-4 weeks est shipping & handling: $100.00 Seq Qty UM Item Number Description Sale Price Extended r el N 2 EA 167377 SHADOW BOX PLATO CORAL 109.000 218.00 769801342060 NATURAL/BROWN 3 EA 196977 SHADOW BOX CLAM 103.000 309.00 769801855270 NATURAUBROWN 3 EA 167177 SHADOW BOX MUSHROOM CORAL 109.000 327.00 769801246436 NATURAUBROWN Customer Copy EFTA00562727 Continued: Bill To SO Seq Qty UM Item Number Description Sale Price Extended ■ F r i 1 EA 198477 SHADOW BOX NAUTILUS 77.000 77.00 769801855294 NATURAL/BROWN 3 EA 197977 SHADOW BOX STARFISH 83.000 249.00 769801855287 NATURAUBROWN 3 EA 167377 SHADOW BOX PLATO CORAL 109.000 327.00 769801342080 NATURAUBROWN Total Line Items = 6 Total # Products = 15 Total CBM= 0.000 Total Shipping Wt = 0 lbs (+=special price applied '=not discounted) Total Cubic Ft= 0.000 Order Acceotar Authorized Signature Position/Title SubTotal $1,507.00 Total $1,507.00 nag Date:649N1 Customer Copy EFTA00562728 PLEASE NOTE: We must havo an application on tile even if you aro requosting CASH terms. All information must be completed. PALECEK DATE Telephone (800) 274-7730 • FAX (510) 236-0561 HER NAME: info@palecek.com HEQUESTEDTERMS CREDIT APPLICATION N3D Nereid-- Please punt or type BILL' CITY bstmosYthF,teame- tchi erarZkO9rgi 0:165 EMAIL STATE 21P STREET CITY ADDRESS OF DIFFERENT THAN ABOVE) ciror -ti WAD cry_, to 1013(c5 STATE ZIP Orinra(s) Address MP Contact Phone /tow long In Cur ness 0-5 months 6,12 moral's _ 1.2 years 2-5 yore CNC/ 5 yeses Licdor your *morals/ the or UtsA,' gel Fedora' D Guiciarchip Soo Preeeetersalp . X_ Cue & &Gestreet • Architect • DesIgner Showroom K MUM/Restaurant O Wholesale PLEASE CHECK THE 80)( NEAREST TO DESCRIBING YOUR BUSINESS O Contract Specifier Li Decorative Accessory 0 Department Sloro Vs:.Dosioner O Floral O Furn'ture CI GIrVStationery U Packer O Lifestyle O Mail Order O Mass Merchant O Nursery O One Tens Buyer O Grocery O Store with DeSigner U Other ESTIMATED ANNUAL RETAIL VOLUME Under $100K O SI00K • MK U $201K - $400K O S401 K • $60oK O Over F.80oK EFTA00562729 BANK REFERENCES BANK ACCOUNT& CITY STATE ZIP TELEPHONE CONTACT NAME ADDITIONAL REFERENCES PLEASE UST COMPLETE NAME, ADDRESS. CITY, STATE, ZIP CODE. TELEPHONE AND FAX NUMBERS & ACCOUNT NUMBER 1) Interest will be added at the rate of 1 1/2% par month (18% per annum on past due amounts) 2) Should il be necessary for Paletek to resod to a collection agency, I agree to pay all costs and Attorney fees. 3) Shortage/damage claims are to be made within 15 days of receipt of merchandise. 4) Invoicing will be made at pending paces. 5) An assessment of $25.00 will to charged on all proved proof-of-deliveries. 8) I hereby authorize our bank 8 trade references to release Information for purposes of granting credit. 7) Affixed signature binds signer to personaSy guarantee payment of amount due. 8) Orders under minimum are subject to a service charge of $35.00 9) Non•sulfldent fund (NSF) Fee $25.00 NAME( SIGNAT POSITION ZED COMPANY EMPLOYEE) 1 DATE EFTA00562730 Nen York Stale Department ot Taxaton and Finance Resale Certificate Single-use certificate Blanket certificate Date issued Temporary ve dors must issue a single-use certificate. Seller information - please type or print Seller's na ST-1 20 (6/99) a 1-ec_,eK Address Oz:0 Nak Lo ie• e3-Alie 5) I State ZIP code I co) (0 Purchaser Information - please printew O r -9 I am engaged in the business of .J6 11) and principally sell (Contractors may not use this cerattate to purchase materials and supplies.) Part 1 - To be completed by registered New York State sales tax vendors c rtify that I am: a New York State vendor (including imissions recipient), show vendor or entertainment vendor. My valid Certificate of Authority Numbe 0 a New York State temporary vendor. ..., ny Number is and expires on I am purchasing: A X Tangible personal property (other than motor fuel or diesel motor fuel) • for resale in its present form or for resale as a physical component part of tangible personal property: • for use in performing taxable services where the property will become a physical component part of the property upon which the services will be performed. or the property will actually be transferred to the purchaser of the taxable service in conjunction with the performance of the service, or B [1 A service for resale. including the servicing of tangible personal property held for sale. Part 2 - To be completed by non-New York State purchasers I certify that I am not registered nor am I required to be registered as a New York State sales tax vendor. I am registered to collect sales tax or value added tax (VAT) in the following state/jurisdiction and have been issued the following registration number (If sales tax or VAT registration is not required and a registration number is not issued by your home jurisdiction, indicate the location of your business and write not applicable on the line requesting the registration number.) I am purchasing: C LI Tangible personal property (other than motor fuel or diesel motor fuel) for resale and it is being delivered directly by the seller to my customer or to an unaffiliated fulfillment services provider in New York State. D Tangible personal property for resale that will be resold from a business located outside New York State. Part 3 - Certification I, the purchaser, understand that: • I may not use this certificate to purchase items or services that are not for resale. • If I purchase tangible personal property or services for resale. but I use or consume the tangible personal property or services myself in New York State, I must report and pay the unpaid tax directly to New York State. • I will incur tax liabilities, in addition to penalty and interest, for any misuse of this certificate. Please type or print Purchaser's naQie as it appears on the sales tax registration Name of owner, partner, or officer of corporation, authorizing the purchase Street E(6O15t- L146 NAOYigit- M Slate acrry: ."-ZIP code 14" Pu Titl utur stantial penalties will result from misuse of this certificate. EFTA00562731