Credit Agreement

Company Information:

Business name_______________________________ Line of Credit Requested $______________

Phone (____)________________________________ Fax (____)___________________________

Address___________________________________________________________ For Past _________years

D/B/A____________________________________________ Federal Tax ID#_______________________

Former Business Address (if applicable)______________________________________________________

Type of Business_____________________ Date Established___________ How long in business________

No. of Employees_________ Est. Annual Sales_______________ Sale Territory__________

Mortgage holder/Landlord_________________________________________________________________

Address________________________________________ Phone #_____________________________

Does State, County, or City require a license? Yes____ No____ License #____________________

OWNERSHIP: Sole Proprietorship_________ Partnership_________ Corporation___________

PRINCIPLE: ________________________________________________________________

(Name) (Title) (SS#)

PRINCIPLE: ________________________________________________________________

(Name) (Title) (SS#)

PRINCIPLE: ________________________________________________________________

(Name) (Title) (SS#)

PRINCIPLE: ________________________________________________________________

(Name) (Title) (SS#)

Accounts Payable Information:

Person(s) in charge of A/P _________________________________________________________________

Billing Address _________________________________________________________________________

A/P Phone (___) ______________________________________ A/P Fax (___) _______________________

Shipping Address _______________________________________________________________________

Do you use internal purchase orders at your company? Yes _____ No _____

TRADE REFERENCES:

Name Address/Phone #

________________________________ __________________________________________________

BANK REFERENCES:

Name Address Acct # Contact

________________________ ________________________ ___________ ______________

Has the firm or any of its principles every been Bankrupt? Yes____ No____

If Yes, explain __________________________________________________________________________

Any misrepresentation in this Agreement will be considered evidence of fraud, since this information is the basis for the extending of credit. As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references and principles listed.

In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed (net 30 days) and agrees to pay a service charge per month of 1-1/2% per month (18% annual percentage rate) on all past due balances. In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees. Whether or not litigation has commenced, and all cost of litigation incurred. The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.

_________________________________

(Name of Business)

_________________________________ ________________ ____________________________

(Print Name) (Title) (Signature)

_________________________________ ________________ ____________________________

(Print Name) (Title) (Signature)

CREDIT RELEASE AUTHORIZATION

For the purpose of obtaining merchandise on credit,

I authorize

Your Bank Name________________________________________________________________________

Address_______________________________________________________________________________

City__________________________________ State___________________ Zip______________________

Phone Number (_____)_____________________ Account Number________________________________

To release credit information to:

Aardvark Forms

32 E. Magnolia Avenue

Eustis, FL 32726

1 (352) 357-5116

As an inducement to grant credit, the undersigned agrees to the need for verification of all information on this agreement and authorizes and releases all banks, businesses and persons identified on this agreement to furnish any and all information requested by Aardvark Forms/Aardvark Forms or its representative, by telephone or written correspondence.

The undersigned warrants that the information is true and correct.

As an inducement to grant credit, the undersigned agrees to Aardvark Forms/Aardvark Forms right to obtain the credit history of the undersigned and authorizes the release of such information by signature here.

Signature_________________________________ Printed Name________________________________

Title_____________________________________ Date_______________________________________

Signature_________________________________ Printed Name________________________________

Title_____________________________________ Date_______________________________________

Mail the completed and signed application to:

Aardvark Forms/Aardvark Forms

32 E. Magnolia Avenue Suite 1

Eustis, FL 32726

Alternatively, you can fax the application to:

1 (352) 357-3067