Company Credit Application Your cooperation in providing the following CONFIDENTIAL information will help us to expeditiously establish your new credit account and to better serve your future business needs. You will be notified by mail or e-mail once your credit line has been approved. Typical response time is 24-48 hours; please let us know if you need your application expedited sooner. If you wish to place an order while this credit application is being reviewed, please use one of our other payment oprtions. Please read carefully, this is a BINDING "CREDIT CONTRACT"; In consideration of credit being granted to me or to my signed agent(s), I agree fully to the following: 1. Our terms of sale are Net-30. Charges of 1.5% per month will be added to invoices not paid within 30 days of the invoice date. (18% per annum) 2. To notify creditor of any change of ownership within 30 days. 3. If this is placed in collections, I agree to pay all reasonable charges including attorney's fee, and further agree that a charge of 20% of the amount of the claim shall be considered reasonable as a fee. 4. Any legal action to collect outstanding receivables shall take place in the State of Connecticut and all Connecticut laws shall apply. 5. You agree to pay all shipping charges and Gemclear handling charges 6. Custom order services may require a 50% deposit upon placement Authorized Signature below is required or Credit Application will be denied Firm Name: ___________________________________________________________________ D&B Number: _________________________________________________________________ Parent Company: Owner or Partner's Name: _________________________________________ Company Website Address: ______________________________________________________ Billing Addres: _____________________________________P.O. Box_____________________ Shipping Address: ______________________________________________________________ City: ________________________________________State: __________Zip: ______________Phone: (Area Code)_________________________FAX: (Area Code)______________________ Name of Primary Contact: ___________________________________________________ Email Address Contact:: ____________________________________________________ Name of Controller/Accounts Payable Contact:________________________________________ Email Address Controller/Accounts Payable Contact:: __________________________________ This location since: _______________________Type of business: (wholesale, retail, distributor, other) Bank Name: _____________________________Checking Account #: ____________________ Address: ________________________________City: ________________State: ____________ Bank Contact Name: ____________________________ E-mail Address: __________________ Trade Reference #1: ___________________________________________________________ Phone: (Area Code) ______________________Fax: (Area Code) ________________________ Trade Contact Name: ___________________________________________________________ Trade Contact Email Address: _____________________________________________________ Trade Reference #2: ___________________________________________________________ Phone: (Area Code) ______________________Fax: (Area Code) ________________________ Trade Contact Name: ___________________________________________________________ Trade Contact Email Address: _____________________________________________________ Trade Reference #3: ___________________________________________________________ Phone: (Area Code) ______________________Fax: (Area Code) ________________________ Trade Contact Name: ___________________________________________________________ Trade Contact Email Address: ____________________________________________________ I hereby grant permission to GemClear and to my listed trade/bank references to verify this information and further, do agree to the terms and conditions as stated to the above six (6) "credit contract" conditions; AMOUNT OF CREDIT REQUESTED: (1,000, 5,000, 10,000, 25,000, 100,000, 250,000), Signed: _______________________________________________Date: __________________ (Only the company owner or his/her authorized agent) Principals Name: ______________________________________ Position: _________________ Phone Number: (Area Code): _____________________________ Extension: _______________ Home Telephone: (Area Code): ___________________________ Do you have an order pending upon this credit approval? (YES NO) PLEASE SIGN AND FAX BACK WITH YOUR TAX RESALE FORM ASAP TO: (877) 411-1873 You may also e-mail the signed application to: creditrequest@gemclear.com (Although we will begin processing your request for credit on receipt of the online form, no references can be verified without receiving the physically signed copy.