CONFIDENTIAL

Account Application

Creative Glass Carving * 1107 S. Lake Michigan Dr. * Sturgeon Bay, WI 54235

voice/fax (920) 746 – 8429

Organization Information:

Organization Name:

Number of Years in Existance:

Organization Type:

O Business O Charitable

O Education O Non-profit

O _______________________

Contact:

Phone:

Email:

Fax:

Address:

City,St:

Zip:

Billing Address:

City,St:

Zip:

Billing Contact:

Phone:

Email:

Fax:

DISCLAIMER:

The Applicant agrees that the Applicant shall be responsible for all merchandise purchased using payment method as

agreed upon when ordering. It is understood that interest accrues on the outstanding balance of each Invoice at 1.5% per

month in the event same is not paid within (30) days of the date of shipment of merchandise as applicable thereto. In the event of default on the account the Applicant agrees to pay all reasonable attorney fees and all costs of collection.

Acceptance and Approval

Signing this agreement indicates your acceptance of the terms and conditions as stated. In addition, you may be reuired to submit a credit application. This signature below is an authorized signer of the applicant organization.

Authorized Signature:

Print Name:

Title:

Date: