Customer Application

Customer Information

Company Name

Mailling Address

City

State

Zip

Business Phone

  e.g., 000-000-0000

Business Fax

  e.g., 000-000-0000

Tax Exempt Yes No

State Tax#

Federal Tax ID#

Bond#

Type Of Business

Business Start Date

A/P Contact

Phone

  e.g., 000-000-0000

Fax

  e.g., 000-000-0000

P/O # Required Yes No

Authorized Purchaser List Yes No

Name Of Business Owner(s)

Officer(s)

Guarantors

Name

Phone

  e.g., 000-000-0000

SS#

Name

Phone

  e.g., 000-000-0000

SS#

Trade / Bank References

Name

Phone

  e.g., 000-000-0000

Fax

  e.g., 000-000-0000

Name

Phone

  e.g., 000-000-0000

Fax

  e.g., 000-000-0000

Bank Name

Acc#

Phone

  e.g., 000-000-0000

We make application to Manor Hardware Inc for credit and/or to update and reconfirm our existing accounts and balances with Manor Hardware Inc. If credit is granted, we promise to pay all bills when rendered. In the event payment is not made, we will pay cost and collection equal to a minimum amount of 25% of the principal amount. Applicant also understands that interest on any unpaid balance will be charged at 18% per annum. If suit or action by an attorney is instituted, we promise to pay reasonable attorney fees in said suit or action. It is specifically understood that all billing, accounts receivable and credit functions are processed through headquarters in Snohomish County,Wa at the option of Manor Hardware Inc. Customer understands that they are waiving their rights to give their permission to Manor Hardware Inc and/or its agents to verify and/or supplement the information stated herein.

By (Owner/Corporate Officer/Partner)

Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2010 2011    

We(I) agree to unconditionally guarantee payment of all sum owed pursuant to this agreement and further agrees to its terms regarding venue. This is intended to be and is a continuing guarantee and shall not be revoked except by written notice to creditor.

Guarantor

Guarantor1

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