CREDIT APPLICATION

Credit Application

SECTION ONE:

Account Information

Date:

D&B Duns #:

Company Name:

Phone Number:

Fax Number:

Billing Address:

City:

County:

State:

Zip:

Ship to Address:

A/P Contact:

A/P Tele Number & Ext:

Purchased Order Required? Yes No

Verbal Orders Allowed? Yes No

Years In Business:

Preferred Method of Invoicing:

Please enter the preferred contact information (email address or fax number)

SECTION TWO:

Trade and Bank References

Company Name:

Phone Number:

Address:

Fax Number:

City:

State:

Zip:

Company Name:

Phone Number:

Address:

Fax Number:

City:

State:

Zip:

Company Name:

Phone Number:

Address:

Fax Number:

City:

State:

Zip:

Company Name:

Phone Number:

Address:

Fax Number:

City:

State:

Zip:

Company Name:

Phone Number:

Address:

Fax Number:

City:

State:

Zip:

Bank Name:

Phone Number:

Address:

Fax Number:

City:

State:

Zip:

SECTION THREE:

Sales Tax Exemption Information

IMPORTANT- PLEASE READ

We collect sales tax from the states of California, Kansas, Missouri, Ohio, and Nebraska (CA,KS,MO,OH,NE) only. Tax is based on where product is shipped to. The rate is calculated on the current City, County, and State tax rate of the location product is shipped to.

Please indicate the County for both your Billing and Ship To addresses.

WARNING: EXEMPTION CERTIFICATES ARE REQUIRED IF YOUR COMPANY IS TAX EXEMPT. AN EXEMPTION NUMBER PRINTED ON A COMPANY LETTERHEAD IS NOT ACCEPTED BY THE U.S. GOVERNMENT AS VALID.

Status: Taxable Tax Exempt

Tax Exempt Number, if applicable:

Orders that are needed before credit process is completed will be shipped on a C.O.D. basis or may be charged to Visa, Mastercard or American Express.

SECTION FOUR:

Statement of Terms

From Date of Invoice: Net 30 Days 45 Days Credit Check 60 Days Credit Hold

Submission of this application attests financial responsibility, ability and willingness of your company to pay Infinity Fasteners, Inc. invoices in accordance with our terms and acknowledges said terms supersedes all others including those listed on customer's purchase orders. Collection fees, reasonable attorney fees and court costs will be added to delinquent accounts requiring any collection or legal action. Application must be submitted by an authorized representative of your company.

Company Name (if different from above):

Name of Applicant:

Title of Applicant:

Date: