NET Terms Application

PLEASE FILL OUT THIS FORM IN ITS ENTIRETY

"*" indicates required fields

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About Your Business

Business Name*

Business Phone Number*

Business Fax Number

Sales Tax ID #*

Billing Information

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Person to contact for payment of invoices:

Contact Name*

Contact Title*

Phone Number*

Email Address*

References

Please provide 3 references that you have done business with in the last five years.

Reference 1

Company Name*

Email Address*

Account Number*

Phone Number*

Fax Number*

Year Account Opened*

Reference 2

Company Name*

Email Address*

Account Number*

Phone Number*

Fax Number*

Year Account Opened*

Reference 3

Company Name*

Email Address*

Account Number*

Phone Number*

Fax Number*

Year Account Opened*

Legal

We certify that the above information is true and correct to the best of our information, knowledge and belief. We agree to pay all charges according to the terms and conditions as stated by DOWN inc. (“Creditor”). If we fail to do so, then we agree to pay any late charges, reasonable collection costs and attorney fees if collection procedures are instituted. Should credit availability be granted by Creditor, all decisions with respect to the extension or continuation of credit shall be at sole discretion of Creditor. Creditor may terminate any credit availability within its sole discretion.

We authorize you to conduct an investigation of our credit worthiness, including but not limited to securing commercial credit reports, consumer credit reports, trade references, lender references, lease references.

We hereby authorize release of credit information to DOWN inc.

Print Name*

Authorized Signature*

*E-Signature accepted as your full authorization.

Title / Position*

Date*

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