PLEASE NOTE:

PLEASE NOTE: We must have an application on file even it you are requesting CASH terms. All information must be completed. PALECEK DATE / / Telephone (800) 274-7730 • FAX (510) 236-0561 REP NAME: REQUESTEDTERM NOO Prepaid info 4a)palecok.com CREDIT APPLICATION Mono print or typo ( ) COMPANY NAME PHONE ( ) COMPANY WOMAN: FURNITURE BUYER FAX ACCESSORY BUYER EMAIL GUANO ADDRESS CITY %., STATE ZIP SHIPPING NAME ANDADDRESS OF DIFFERENT THAN ABOVE) SHHPP01G NAME STREET CITY STATE ZIP Ownw(s) Address AP Canted Phone How tong In (WOWS 0-S morals I2 moats 1.2 years 2.5 yeast Over S yews Under your a:ramble Type of f3uPriess? Corp Parinership Sao Propeetoahlp Federal I D e Dun & &Mine? I O Architect O Designer Showroom K Hotelifiesteurant o Wholesale PLEASE CHECK THE BOX NEAREST TO DESCRIBING YOUR BUSINESS O Contract Specifier O Floral O Lifealykr O One lime Buyer O Oecorative Accessory O Fumlure O Malt Order O Grocery O Department Stow o GlIVStationery O Mass Merchant O Store with Designer o Designer O Newt O Nursery O Other is O Under STOOK O $100K $200K ESTIMATED ANNUAL RETAIL VOLUME K $201K - WOK O $401K • S000K EFTA00308077 BANK REFERENCES BANK ACCOUNTN CITY STATE ZIP TELEPHONE CONTACT NAME ADDITIONAL REFERENCES PLEASE LIST COMPLETE NAME, ADDRESS, CITY. STATE, ZIP CODE, ELEPHONE AND FAX NUMBERS & AC,CCUM NuMBER 1. 7 TERMS AND CONDITIONS IN APPLYING FOR OPEN ACCOUNT PRIVILEGES, I AM AWARE OF THE FOLLOW WO AND AGREE TO THESE TERMS. I) Were.% will be added al the rate of 1 1/2% per month (18% per annum on past due amounts) 2) Should i bo necessary for Palecok to resort to a oolkicilon agency, I agree to pay oil oasts and Attorney fees. 3) Shortage/damage dakns are to be made 'Whin 15 days of receipt of merchandise. 4) InverIcIng will be made al prevailing prices. 5) An assessment of 525.00 will be charged on all proved proof-of-deliveries. 6) I hereby authorize our bank & bade references to release automation lot purposes of granting crock 7) Armed signature hinds signor to personaty guarantee payment of amount due. 8) Orders under minimum we subtract to a sendce charge of 535.00 9) Non.stAticionl fund (NSF) Fee 525.00 NAME (PLEASE PRINT) POSITION SIGNATURE (CORP. OFFICER, PARTNER, SOLE PROPRIETOR OR AUTHORIZED COMPANY EMPLOYEE) DATE EFTA00308078