Credit Application

Please complete all items or the application will be delayed.

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Type of Company:

Estimated Credit (Per Month):

Company Name:

Street Address (Non-PO box):

Billing Address:

City:

State:

Zip:

Telephone:

FAX Number:

E-Mail Address:

Parent Company (If subsidiary):

Name of Contractor License Holder:

License Number:

Class:

What type of business?

Sole ProprietorPartnershipCorporation

Do you require a Purchase Order?

YesNo

If you use job accounts, do you want a separate statement for each job?

YesNo

Principal/Partners Information:

State of Incorporation:

Date of Incorporation:

Names/ Addresses of Owners/Principals:

Name:

Address:

City:

State:

Zip:

Title:

Driver's License #:

Social Security #:

Date of Birth:

Home Telephone:

Business Telephone:

Taxpayer ID Number:

Taxable

YesNo (If No please provide resale number)

Resale Number:

Principal/Partners Information:

State of Incorporation:

Date of Incorporation:

Names/ Addresses of Owners/Principals:

Name:

Address:

City:

State:

Zip:

Title:

Driver's License #:

Social Security #:

Date of Birth:

Home Telephone:

Business Telephone:

Taxpayer ID Number:

Taxable

YesNo (If No please provide resale number)

Resale Number:

Trade References: (Must be at least 3 or attach your own sheet)

Name:

Telephone:

Fax:

Name:

Telephone:

Fax:

Name:

Telephone:

Fax:

Have you ever done business with Smardan Supply previously?

YesNo (If yes, please list the name)

(If yes, please list the name).

Has an applicant or any principal thereof ever filed for bankruptcy?

YesNo (If yes, attach sheet giving full and complete details)

Bank References:

Bank Name:

Address:

Contact Officer:

Account Number Market:

CheckingSavingMoney

Account Number Market:

CheckingSavingMoney

Preferred Location:

Terms and Conditions

Terms of Sale: Our standard terms are Net 30 days. A finance charge of 1-1/2% per month and an annual percentage rate of 18% charged on all past due (over 30 days) accounts.

Personal Guarantee - In consideration of Smardan Supply extending credit hereunder, the undersigned personally, jointly and severally and unconditionally guarantee and promise to pay Smardan Supply on demand, any and all indebtedness of the above-named applicant to Smardan Supply. This is a continuing guarantee and the obligations created hereby are unaffected by any change in the terms of the original indebtedness between Smardan Supply and above-named applicant, save that of payment. This guarantee shall continue in effect until the undersigned has notified Smardan Supply in writing of its cancellation, but such cancellation shall not alter any obligation of the undersigned prior to such written notice.

Note: In the event that Smardan Supply offers an extension of credit to the above-named credit applicant and/or guarantors on the above terms or on any other terms agreed on by said credit applicant and Smardan Supply, said extension of credit is issued pursuant to the information and financial representations made herein by said applicant and/or said guarantors.

COLLECTION, VENUE, AND JURISDICTION - Applicant and Personal Guarantor(s) agree(s) to pay any and all actual costs of collection, including attorney's fees and court costs incurred in the collection of the sums due hereunder if necessary for the collection of the applicant's account with Smardan Supply.

This agreement is governed by the laws of the state in which the Smardan Supply credit office accepting this application is located, as indicated on the face of this application. In California, venue for any legal action is expressly agreed hereunder to be proper Counties of Orange, Los Angeles, Santa Barbara, or San Luis Obispo, California, as Smardan Supply exclusively deems proper. In all other states, the venue for any legal action shall be in the County chosen by Smardan Supply in its sole and exclusive discretion. Applicant and Personal Guarantor(s) hereby expressly waive(s) any venue objection and consent to the venue and jurisdiction as selected by Smardan Supply.

I have read and agree to the Terms and Conditions