EFTA02322501.pdf

PLEASE NOTE: We must have an application PALECEK• #I DATE •__ / / 7 on file even if you aro Telephone (800) 274-7730 • FAX (510) 236-0561 REP NAME: requoSting CASH terms. [email protected] REQUESTEDTERM& All information must be completed. N-30 Prepaid CREDIT APPLICATION Ploaso print or typo I ( ) COMPANY NAME PHONE COMPANYWEBSUE: ( FURNITURE BUYER FAX ACCESSORYBUYER EMAIL BALINGADDRESS crry STATE ZIP SHIPPING NAME ANDADDRESS (IF DIFFERENT THAN ABOVE) SHIPPING NAM STREET OW STATE 7JP Oenabe Address AN Contact Plano How tong In business 0-5 males 6.12 months 1.2 years 2-5 years_ _ °Verb years Linda your Ownership Type Of Simkins? Corp Par•nershp Solo Prosidetorslop Fedwat I 0 Dun& EkadskoN I PLEASE CHECK THE BOX NEAREST TO DESCRIBING YOUR BUSINESS U Architect CJ Contract Specifier U Oecoradye Accessory O Department Store O Designer O Designer Showroom U Floral O Furniture U GIttiStatIonory U Packer U I loloVHeslutorant U Lifestyle O Mail Order O Mass Merchant U Nursery wholesale O Ono limo Sum U Grocery O Store with Designer O Oilier ESTIMATED ANNUAL RETAIL VOLUME U Under $100K ❑ $100K • $200K ❑ $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_01235033 EFTA02322502