APPLICATION FOR INSTANT CREDIT

      PLEASE PRINT

      *NAME OF BUSINESS:_______________________________________________________________

      *NAME OF ACCOUNT: _______________________________________________________________
      (if different from above)

      *BILLING
      ADDRESS: ________________________________ *CITY ________________ *ZIP _______

      *SHIP TO
      ADDRESS: ______________________________ *CITY ________________ *ZIP _______
      (if different from above)

      IS LOCATION ACCESSABLE FOR A 25' TRUCK? YES________ NO________

      *PHONE: _________________________________________ FAX: ____________________________

      CONTACT NAME: _______________________________________ TAX %: ____________________

      A/P CONTACT: _________________________________________ FAX: ______________________

      OWNER/OFFICER FULL NAME: ______________________________________________________

      YEAR ESTABLISHED: _______________________________________ RESALE#______________

      DOES YOUR COMPANY USE A PURCHASE ORDER SYSTEM:     YES ___ NO___

      DESIRED CREDIT LIMIT: __________________

      HOW MANY PEOPLE IN YOUR OFFICE: __________________

• Payment for full account balance is due and payable on or before the 10TH day of every month. We do not offer a revolving type of charge account nor are we in a position to offer a carry over balance.
• Any amount not paid by the 10TH day of the month is considered past due and is recorded in our credit history data bank, which is kept for the purpose of rating each account, and providing requested references.
• Palace Art & Office supply reserves the right to obtain a security interest in the products sold to the customer and it's proceeds thereof until the customer makes payment in full.
• Any amount not paid within 30 days of the statement date of the 25TH day of the month is subject to an interest/finance charge of 1.5% per month on the unpaid balance (18% annually) with the minimum charge of 50 cents.
• Palace Art & Office Supply reserves the right to recover any attorney fee's or collection costs expended to collect on past due balances.
• The undersigned understands and agrees to, and will abide by, the above stated terms.

      *Authorized Representative: ___________________________________________ *Date: _______________

      *Print Name: _________________________________________________ *Title: ______________________

      This application is not valid unless signed. A faxed application will be deemed as original.

_______________________________________________________________________________________
    2606 Chanticleer Ave., Santa Cruz, CA 95065 • (831)476-3815 • FAX (831)476-4036    

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