CONFIDENTIAL

CREDIT APPLICATION

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

voice/fax (920) 746 – 8429

Company Information:

Company:

Phone:

Fax:

Address:

City,St:

Zip:

Billing Address:

City,St:

Zip:

Billing Contact:

Phone:

Email:

Number of Years in Business:

D and B Number:

State Incorporated:

Trade Reference:

Company:

Address:

City,St:

Zip:

Contact:

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Terms:

Credit Limit:

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 authorize Creative Glass Carving to make any and all inquiries necessary to process this Credit Application including releasing information about your bank account for the purposes of establishing credit with Creative Glass Carving. I am authorizing my banker to release information regarding my accounts history, average balance, and standing. This signature below is an authorized signer of the applicant company and an authorized signer on the account listed below.

Bank:

Phone:

Account:

Authorized Signature:

Print Name:

Title:

Date: