DS9 Document EFTA00525149

STARK COMPANY INFORMATION Company Name Billing Address Phone] CARPET FABRIC WALLCOVERING FURNITURE CONFIDENTIAL ACCOUNT APPLICATION ALL NEW ACCOUNTS ARE PROFORMA ACCOUNTS 979 Third Avenue New York, NY 10022 Credit Department Tent 212-752-9000 En. 7136. Fax* 718-784-0731 JSC,T,44,„io/zs LI-C._ 575 Letr,:lioN e9-ve, 967cian.. Contact 4,2 ?k,b,4ed /44../ City IVY Fax Email Bank Reference Avisaas 64.4(.-Account ft Years in Business Lit State AJ r Zip 1000,1•Q Bank Contact Silevidizef op;e1g Phone Tyne of Business: "(Interior Designer • f Architect • I.• Specifier • fl Purchasing Agent • L: Hospitality • P Contract • Other Dun & Bradstreet,/ OWNER INFORMATION (Must be completed for all partnerships and sole proprietorships) Check One: IT Corporation • OCLIC • U Partnership • U Sole Proprietorship • Owners Full Name Cilome Sipcfram SS# Federal ID # Owners Address 515" ig,1/4,-;v0 1/44,40/ va City AV/ State /4 V Zip /00.2,) Partners Full Name ( If Partnership ) SS# Partners Address City State Zip TRADE REFERENCES I. Name hYlan/the;fq Phone Account(' Address City State Zip 2. Name At+ Phone goo- bLfc lot fi Account# Address City State Zip 3. Name Phone Account(' Address City State Zip I authorize Stark Carpet Corp. o con interest at a rate of I Si% per mon ( my failure to pay any unpaid bat interest and fees by said firm i to the terms and conditions. Authorized Signature Office Usc Only Carpet Salesperson#: Account # t any of my references as well as my banking, business and consumer reporting agencies in order to establish credit terns. I agree to pay % per annum) for all np id past due invoices. I also agree to pay reasonable costs of collection, including attorney's fees, in the event of n consideration of th t o a/15, col ection ipt of goods and services by said firm, the undersigned do contractually and personally guarantee all payments, y unpaid balances. I have read and understand these terms set forth within this account application and fully agree Title A14/014,j4 Date f/t1/26 0/19 Entered By Branch Date 979 Third Avenue New York, NY 10022 • T 718-683-5100 Ext# 7136 • F 718-784-0731 • E • • 111/2014 EFTA00525149 trees York Stele Department of Taxation and Finance Safes Tex Regisbabon WA Harriman Carpus Abany NY 122274865 a. JSC INTERIORS, LW CIO RICHARD KAHN, MANAGER 575 LEXINGTON AVE FL 4 NEW YORK NY 10022-6146 New York Stale Department of TaxatiOn and Finance Certificate of Authority r Identification number 47.2294796 1 (Use th.5s number on al ralurns'and correspondence) JSC INTERIORS, LLC C/O RICHARD KAHN, MANAGER 575 LEXINGTON AVE FL 4 NEW YORK NY 16022:6146 VALIDATED 12/4/2014 Dept of Tax and Finance is authorized to collect sales and use taxes under Articles 28 ono 29 of the Nay York Slate Tax Law. Nontransferable This certificate must be prominently displayed at your place of business Fraudulent or other improper use of this certificate will cause it to be revoked The certificate may not be photocopied or reproduced. 4020109100098 IDES - 3390635 F0000053. 01 DTF-17-A111114/ EFTA00525150