ATTN: Fabricut, Inc. Brand Focus V4 CREDIT APPLICATION G Fabricut O Stroheim ) Trend O Vervain OS, Harris FABRICUT O Pabricut Contract D Export Business Information Business Legal Name Trade Name EEE Subsidiary or Division of. Mailing Address ——________________ City, State, Zip Shipping Address_________________ City, State, Zip Phone ____ Pax CE Maaill Company Type: 0 Corporation, what state _ COLL O Proprietorship O Partnership Federal ID No___SECSséOVeeaar Established Preferred Account Terms: D Open, net 30 OCOD O CBD (Proforma) ffi n r Propri 1 2. 3. US, Trade References Company Name Phone Number Fax Number Account Number 1 2 3. Sales Tax Exemption O RESALE CERTIFICATE. 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) eee re for Wholesale OF resale of are ingredients or components of a new product to be resold, leased, or rented in the normal course of business, We further certify that if any property so purchased tax free is used or consumed by us making it subject toa 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 cach order which we may hereafter give you, unless otherwise specified, and shall be valid until cancelled by us in writing or revoked by the city or state. We also agree to reimburse you for any sales tax later determined by Fabricut, Inc. to be due and payable. 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 DO NO EXEMPTION CERTIFICATE. We hold no exemption certificate and shoukl be chamed all applicable taxes. T L Condit We agree that the standard terms of sale for Fabricut, Inc. are net 30 days from date of invoice and that shipments will be held if our account becomes delinquent. All orders are subject to credit approval when received. A service charge of 1 Y% per month will be charged on balances not paid within terms, In the event of default in payment, we agree to pay all collection fees, court costs, attomey fees and interest incurred through collection procedures. We understand that the information included in this application is for the use 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 references and report our credit performance to the proper persons and credit bureaus, Owner or Officer’s Signature Tithe Cate INTERNAL USE ONLY OSample ONSA Sales Rep Date Ter Br Sec O/E FAB - LRS P.O, Box 470490, Tulsa, OK 74147-0490 FAB-090 ROS/10 PHONE: 800-999-8200 FAX: 800-888-7171 EFTA00521643