Del City Interactive Catalog Page 362

362 N85 W12545 Westbrook Crossing, Menomonee Falls, WI 53051 credit application CREDIT APPLICATION please fax to 1.800.431.1293 or account no. (if current customer) contact / buyer: company name email address address city state zip phone fax check one: individual partnership corporation Dun & Bradstreet no. debtor (individual and partnership only) title years in business (required) no. of employees (required) taxable yes no tax rate: % If NO, please fax tax exemption certificate trade references please provide fax numbers name phone address city state zip fax name phone address city state zip fax name phone address city state zip fax name phone address city state zip fax bank reference please provide fax number name phone address city state zip fax Applicant's signature attests to the company's financial responsibility, ability and willingness to pay invoices in accordance with the terms and condition of sale. In the event that account is not paid within the terms of Net 30 from the date of the invoice, orders are subject to being held until payment is received to bring account current. In the event that the account passes 90 days past due, the undersigned is subject to being placed for collections and assessed an interest of 18% per annum, as well as all costs of collections, including reason- able attorney's fees, if collected by law or through our collection agency. A $30.00 charge will be assessed for all returned checks. If an account remains unused for 6 months a new credit application must be resubmitted. print name: date: by: title:

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