Credit Application Form

13212 Saticoy Street North Hollywood, California 91605 P 818.982.1711 F 818.982.2764

APPLICATION FOR CREDIT

Cust No: ___________________ Discount: ___________________

___________________________________________ _____________________________ _____________________________

Company

Phone No

Fax No

____________________________________________________________ ______________________ ______ ____________

Billing Address

City

State Zip Code

____________________________________________________________ ______________________ ______ ____________

Billing Address

City

State Zip Code

____ Corporation

____ Partnership

____ Sole Proprietorship

____ Other __________________________________________ (Please Specify)

__________________________________________________ ______________________________________________________

Federal ID

Resale No (Please include copy)

Officers and Principals:

Title:

SSN:

DOB:

______________________________________ _______________________ _______________________ _______________

______________________________________ _______________________ _______________________ _______________

______________________________________

Bank Name:

Account No.:

_______________________ Address:

_______________________ _______________ Phone:

_______________________ ____________________ _________________________________________ ________________

_______________________

Trade References Company Name

____________________ Address

_________________________________________ ________________

Phone

Fax

________________________ ____________________________________________ ________________ _________________

________________________ ____________________________________________ ________________ _________________

________________________ ____________________________________________ ________________ _________________

________________________ ____________________________________________ ________________ _________________ In consideration, which may be granted by Vendor to the above named company or to the undersigned, or either of them, it is expressly agreed as follows:

You or your agents are authorized to secure any credit information which you may reasonably require. All payments are to be made at above Vendor's address. In the event of default in payment of the account of the above named company or the undersigned, all sums shown on the current statement, including all finance and service charges shall become due and payable at the option of Vendor, and such finance and service charges shall continue to accrue and shall be collectible against the undersigned company and/or the undersigned individual together with reasonable attorneys fees and costs. It is agreed that attorneys fee in an amount of 25% of the unpaid balance of the account is reasonable. It is understood that the following terms relate to all purchases by the above named company and/or the undersigned:

ALL ACCOUNTS ARE DUE AND PAYABLE NET 30 DAYS FROM DATE OF INVOICE. A FINANCE CHARGE OF 1 1/2 % PER MONTH, WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% IS CHARGED ON ALL PAST DUE ACCOUNTS. AS TO NON-CONSUMER ACCOUNTS, SAID CHARGE IS A SERVICE CHARGE AGREED AS REASONABLE LIQUIDATED DAMAGES. ACTUAL DAMAGES BEING DIFFICULT TO ASCERTAIN. In order to induce you to extend credit to the applicant. It is represented that neither the applicant nor the undersigned individual has ceased to pay debts in the ordinary course of business; that the party responsible therefore is capable of paying said obligation when the same becomes due and is not insolvent within the meaning of the Federal Bankruptcy Act. The undersigned and each of us do hereby agree to notify Vendor in the event of any change of status of the applicant or the undersigned with respect to the foregoing representations and further agree to notify Vendor as to any change of address of either of said parties or to any change of location as to where materials purchased from Vendor are being delivered or used.

Date: __________________________

Company:______________________________________________________________________________________________________________

__________________________________________________________________________________ Signature of Applicant

_____________________________________________________________________________ Signature of Applicant

__________________________________________________________________________________ Signature of Applicant

_____________________________________________________________________________ Signature of Applicant

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