CUSTOMER INFORMATION Company Name: FEIN#: Applicant Name: Address 1: Address 2: City: State: Zip: Phone: Fax: Email: Website: Type of Business/Government Agency: Sole Proprietorship Corporation Partnership Federal Government State Government Local Government Other Description of Business: Date Established: Sales Tax Exempt # (Please mail, fax, or email a copy of your certificate.): Total # of Employees: # of Employees at this Location: PO Required?: Yes No Do you receive a subsidy?: Yes No If yes, how much is your subsidy?: If yes, is payroll deduction allowed?: Yes No N/A Do you have a voucher system for employees who are approved?: Yes No If not, do you have a list of eligible employees?: Yes No N/A Terms Requested: OWNERSHIP/EMPLOYEE INFORMATION Owners/Principals: Name: Title: Phone: Address: Name: Title: Phone: Address: AP Contact Name: AP Contact Phone: AP Contact Email: Purchasing Contact Name: Purchasing Contact Phone: CREDIT REFERENCE Name of Bank: Account #: Address: Phone: Fax: TRADE REFERENCES Name: Phone: Address: Name: Phone: Address: Name: Phone: Address: TERMS & CONDITIONS The information supplied in this application is warranted to be true and correct and is provided to Blue Collar Workwear for the purpose of obtaining credit. I/We fully understand and agree to payment of TERMS AS REQUESTED, upon approval of this credit application and further agree to accept and pay for any financial expenses incurred by Blue Collar Workwear to collect any of our past due amounts, including but not limited to, the original debt, any assigned reasonable collection costs, attorney fees, and any other related expenses. RELEASE AUTHORIZATION I/We hereby authorize the release of any account or credit information requested by the creditor named above. Please respond to their telephone request or by fax if you need written proof of this release authorization. Digital Signature (Authorized Individual): Date: Title: TERMS GOVERNING YOUR ACCOUNT Description of Account: Upon approval, the Creditor will provide Debtor with a credit account that requires repayment under the terms and conditions described herein. Debtor agrees to pay for all purchases and finance charges made on the account. Invoice and Statements: You will receive an invoice for each purchase. In addition, you receive statements which will include any applicable finance charges. Finance Charges: You pay a finance charge for any portion of your balance due that is past the terms specified on this agreement. Accounts past due will be charged 1.5% per month. Default: You will be in default of this agreement if any balance remains unpaid in excess of sixty days without notice of dispute. We have the right to demand full payment of the entire balance at that time. If your account is referred to an attorney for collection, you will be responsible for a reasonable attorney's fee.All prices are subject to change without notice. Please enter the following code into the box provided: