Cornell Communications Credit Application

CONFIDENTIAL CREDIT APPLICATION this form PRINT or TYPE and Fax to 414 351 4657 Application Dated as of Communications Inc N 81st Street WI 53223 3830 type or print clearly obtain credit from creditor customer agrees to creditor usual terms and conditions as promulgated and by creditor from time to time and represents and states the following and authorizes release of any pertaining to customer financial conditions form any third parties which may verify same is CORNELL Communications Inc is Address CUSTOMER is a check where appropriate Telephone FA Tax Exempt OWNER Other Partners Attach List State of Incorporation President Owner President Partner BUSINESS REFERENCES Trade names and other business information Complete reverse side Customer agrees to Net 30 terms or pay service charges of 2 per month or the highest rate allowed by law is the lesser from the due date of each invoice to date of payment In event customer account is for collection customer agrees to collection and or attorney fees of 25 of the amount owed agrees that any dealings between the parties shall be governed by and interpreted in with the laws of the State of Wisconsin and customer further agrees per creditor option the jurisdiction of the courts of Wisconsin State or Federal to determine any controversy arising in dealings PERSONAL GUARANTEE In consideration of creditor extending credit to customer the personally and individually guarantee unconditionally full and prompt payment of past and future obligations and terms due creditor from customer and or any successor in interest or non corporate to customer business hereby waiving notice of acceptance of this notice of rendering services and or sale of goods provided customer by creditor and notice of or change or extension of credit terms The undersigned consent to any creditor until revoked writing Any married individual signatory to this application represents that any credit granted to the subject account is an obligation incurred in the interest of his or her marriage or family partners or officers of customers should sign Pri Pri Pri Name Name Name Other Person Business Started Bank Account Reference of Bank Employees of Your Business Nature of Your Business Circle Fire Products Sold Lines Represented Annual CORNELL Purchases Limit Requested Contact s Contact Trade Names supply us with a copy of your Annual Resale Certificate for Sales Tax References at Least Three Will Be Paid in Days Name Your number Person FAX Attach Current Financial Statement of Customer Secured Creditors