We must have an application >: . on file even if you are Telephone (80U) 274-7730 * FAX (510) 236-0561 REP NAME: requesting CASH terms. info@palecek.com ESTED All information must be va — completed. CREDIT APPLICATION N@O____ Prepaid __ EMAIL STATE mw SHIPPING NAME AND ADDRESS (IF DIFFERENT THAN ABOVE) SHIPPINGNAME STREET . cry STATE ae 2-5 yours Over S years Liat | | | How long in business «= OS months 6-12 months 1-2 years Under your ownership Type of Business? Corp _ Partnership ‘Sole Propriatorship Federl | De Dun & Gradatreet # 3 i i PLEASE CHECK THE BOX NEAREST TO DESCRIBING YOUR BUSINESS O Architect Q Contract Specifier O Decorative Accessory 0 Department Storo O Designer 0 Designer Showroom © Floral O Furniture OD GifvStationery GO Packer O HolteVRestaurant O Lifestyle O Mait Order O Mass Merchant GO Nursery O Wholesaie 0D One Time Buyer GO Grocery Q Store with Designer O Other SUL ESTIMATED ANNUAL RETAIL VOLUME i Q Under $100K O $100K - $200K O $201K - $400K O $401K - $600K Q Over $600K i EFTA00308077

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BANK REFERENCES BANK ACCOUNTH cry STATE ZIP — TELEPHONE CONTACT NAME ADDITIONAL REFERENCES PLEASE LIST COMPLETE NAME, ADDRESS, CITY, STATE, ZIP CODE, TELEPHONE AND FAX NUMBERS & ACCOUNT NUMBER TERMS AND CONDITIONS IN APPLYING FOR OPEN ACCOUNT PRIVILEGES, | AM AWARE OF THE FOLLOWING AND AGREE TO THESE TERMS. 1) Interest will be added at the rate of 1 1/2% per month (18% per annum on past due amounts) 2) Should it be necossary for Palocak to resort to a collection agency, | agree to pay ail costs and Attomey fees, 3} Shortage/damage clalms are to be made within 15 days of receipt of merchandise. 4) Invoicing will be mado at provaiting prices. 5) An assessment of $25.00 will be charged on ail proved proof-of-delivaries. 6) | hereby authorize our bank & trade references to release information for purposes of granting credit. 7) Affixed signature binds signer to personally guarantee payment of amount due. 8) Orders under minimum are subject to a service charge of $35.00 9) Non-sutficiont fund (NSF) Fee $25.00 NAME (PLEASE PRINT) POSITION DATE SIGNATURE (CORP. OFFICER, PARTNER, SOLE PROPRIETOR OR AUTHORIZED COMPANY EMPLOYEE) EFTA00308078