Golden Group International, Ltd.

Credit Application for a Business Account

Business Contact Information

Title:

Company name:

Phone:

Fax:

E-mail:

Federal tax ID#

Date business commenced:

Sole proprietorship:

Partnership:

Corporation:

Other:

Business and Credit Information

Primary business address:

City:

State:

ZIP Code:

How long at current address?

Telephone:

Fax:

E-mail:

Bank name:

Bank address:

Phone:

City:

State:

ZIP Code:

Type of account

Account number

Savings

Checking

Other

Business/trade references

Company name:

Address:

City:

State:

ZIP Code:

Phone:

Fax:

E-mail:

Type of account:

Company name:

Address:

City:

State:

ZIP Code:

Phone:

Fax:

E-mail:

Type of account:

Company name:

Address:

City:

State:

ZIP Code:

Phone:

Fax:

E-mail:

Type of account:

Agreement

1.   All invoices are to be paid 30 days from the date of the invoice. Credit Cards (Visa/MC only) are accepted with purchase order – net. Checks 1%/10days net 30. Initial orders require credit card payment.

2.   Claims arising from invoices must be made within seven working days.

3.   By submitting this application, you authorize Golden Group International  Ltd. to make inquiries into the banking and business/trade references that you have supplied.

Signatures

Title:

Date:

Title:

Date: