EFTA02322501

PLEASE NOTE: We must have an application on file even if you aro requoSting CASH terms. All information must be completed. I COMPANY NAME FURNITURE BUYER PHONE ( FAX PALECEK• #I 7 Telephone (800) 274-7730 • FAX (510) 236-0561 [email protected] CREDIT APPLICATION Ploaso print or typo DATE •__ / / REP NAME: REQUESTEDTERM& N-30 Prepaid ( ) COMPANYWEBSUE: ACCESSORYBUYER EMAIL BALINGADDRESS crry STATE ZIP SHIPPING NAME ANDADDRESS (IF DIFFERENT THAN ABOVE) SHIPPING NAM STREET OW Oenabe Address AN Contact STATE 7JP Plano How tong In business 0-5 males 6.12 months Linda your Ownership Type Of Simkins? Corp Fedwat I 0 Par•nershp 1.2 years 2-5 years_ _ °Verb years Solo Prosidetorslop Dun& EkadskoN I U Architect O Designer Showroom U I loloVHeslutorant wholesale PLEASE CHECK THE BOX NEAREST TO DESCRIBING YOUR BUSINESS CJ Contract Specifier U Floral U Lifestyle O Ono limo Sum U Oecoradye Accessory O Furniture O Mail Order U Grocery O Department Store U GIttiStatIonory O Mass Merchant O Store with Designer O Designer U Packer U Nursery O Oilier U Under $100K K $100K • $200K K ESTIMATED ANNUAL RETAIL VOLUME $201K $400K 0 $401K • $600K U Over $600K EFTA_R1_01235032 EFTA02322501 BANK REFERENCES BANK ACCOUNT" CRY STATE TELEPHONE CONTACT NAME ADDITIONAL REFERENCES PLEASE LIST COMPLETE NAME. ADDRESS, CITY, STATE, ZIP CODE, TELEPHONE AND FAX NUMBERS & ACCOUNT NUMBER 1. 2. 3. TERMS AND CONDITIONS INAPPLYING FOR OPEN ACCOUNT PRIVILEGES, I AM AWARE OF THE FOLLOWING AND AGREE TO THESE TERMS. 1) Interest will be added at the rate ol 1 1/2% per month (18% per annum on pest due amounts) 2) Should It be necessary for Palocek to resort to a collection agency, I agree to pay all costs and Attorney tees. 3) Shortage/damage calms aro to be made within 15 days of recelpl of merchandise. 4) Invoickig will be made at prevailing prices. 5) An assessment of $25,00 will be charged on aft proved proof-el-deliveries. 6) I hereby authorize our bank & Irade references to release &Normalion for purposes of granting credit. 7) Affixed signature binds signor to personalty guarantee payment of amount duo. 8) Orders under minimum are suberti to a service charge of $35.00 9) Non-sufficient fund (NSF) Fee $25.00 NAME (PLEASE PRINT) POSITION SIGNATURE (CORP. OFFICER, PARTNER, SOLE PROPRIETOR OR AUTHORIZED COMPANY EMPLOYEE) DATE EFTA_R1_0 1235033 EFTA02322502