Creditor Application Form

CREDITOR APPLICATION FORM AND CREDIT AGREEMENT

Recitals

WHEREAS, Applicant: (the "Applicant") seeks an extension of credit from Creditor: (the "Creditor");

WHEREAS, Applicant has completed this Creditor Application Form to provide information necessary for Creditor's evaluation of creditworthiness and to evidence the Applicant's agreement to the terms that will govern any credit extended;

NOW, THEREFORE, in consideration of the mutual covenants set forth herein and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged, Applicant submits this application and agrees that, upon approval and any extension of credit, the terms of this Credit Agreement will govern the credit relationship.

Applicant Information

Corporation LLC Partnership Sole Proprietor

Credit Request

Trade References (Provide three if available)

Financial Information

Scope of Work / Use of Credit

Payment Terms

Credit Limit to be established (if approved):

Standard Payment Schedule: Net days from invoice date. Alternative schedule or discounts (if any):

Late Payment Fee: ; Interest on overdue balances accrues at unless limited by applicable law.

Applicant agrees to pay all collection costs, including reasonable attorneys' fees and court costs, incurred by Creditor to collect delinquent amounts.

Term and Termination

Term Commencement Date: . Term End Date: .

Either party may terminate this credit arrangement for convenience upon days' prior written notice to the other; Creditor may suspend or terminate credit immediately upon Applicant's insolvency, bankruptcy filing, material misrepresentation, or failure to timely pay amounts due.

Confidentiality

Each party shall treat non-public financial information and business details obtained in connection with this application and any credit relationship as confidential and shall not disclose such information except (i) to the extent required by law or regulation, (ii) to counsel, accountants, or auditors bound by confidentiality, or (iii) with the prior written consent of the other party. This obligation survives termination of any credit relationship for a period of three (3) years.

Authorizations and Certifications

Applicant certifies that all information supplied in this application is true, correct and complete. Applicant authorizes Creditor and its agents to obtain and exchange credit information, bank references, trade references, and other information reasonably necessary to evaluate creditworthiness and to monitor credit during the term of any credit relationship.

I authorize the release of credit and financial information to Creditor: Yes

Governing Law; Entire Agreement

This Application and any resulting Credit Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles. Exclusive venue for disputes shall be in the state or federal courts located within that state.

This Application, together with any credit terms, invoices, schedules, statements of account, and a written credit approval from Creditor, constitutes the entire agreement between the parties relating to the subject matter and supersedes all prior proposals, representations, and agreements, whether written or oral. No amendment or waiver of any provision shall be binding unless in writing and signed by both parties.

Acknowledgment

Applicant acknowledges that submission of this form does not guarantee approval of credit. Creditor reserves the right to require additional documentation, to set conditions on credit, to require personal guarantees, and to impose security interests as a condition of credit approval.

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