Fill and Sign the Idaho Statutory Form Power Attorney

COMMERCIAL CREDIT APPLICATION DATE: _______________________________________ CREDIT REQUESTED: ______________________________________ Company: ___________________________________________________________________________________________________ Address: ___________________________________________________________________________________________________ City: _________________________________________ State: ___________________________ Zip _________________________ Telephone: ____________________________________ Fax # ______________________________________ Name of accounts payable contact: _________________________________________________________Title: __________________________________ Annual sales: _______________________ State of incorporation: ____________________ Year incorporated or registered: ____________________ Corporation OWNERSHIP: TRADE REFERENCES BANK REFERENCES Partnership Individual Name: __________________________________________ Address:__________________________________________________ Title: ____________________________________________ ______________________________________________________________ % Ownership: ___________________________________ Telephone: _______________________________________________ Name: __________________________________________ Address:__________________________________________________ Title: ____________________________________________ ______________________________________________________________ % Ownership: ___________________________________ Telephone: _______________________________________________ Name: __________________________________________ Address:_________________________________________________ Contact name: ___________________________________ Telephone: _______________________________________________ Name: __________________________________________ Address:_________________________________________________ Contact name: ___________________________________ Telephone: _______________________________________________ Name: __________________________________________ Address:_________________________________________________ Contact name: ___________________________________ Telephone: _______________________________________________ Name: __________________________________________ Address:__________________________________________________ Office: __________________________________________ ______________________________________________________________ Account No.: ____________________________________ Telephone: _______________________________________________ In consideration for credit being extended, I or we acknowledge and agree to the following: (1) Payment is jointly, severally and unconditionally guaranteed within 30 days of date of delivery, (2) any charges unpaid after the above 30 days are to be increased by 1 1/2% per month; (3) any charges still outstanding after 90 days from date of delivery are subject to collection, and all collection or arbitration expenses, attorneys' fees, and court costs will be paid by the purchaser; (4) title to all work shall remain with the creditor until all invoices and additional charges have been paid in full; (5) all claims, requests for adjustments, or notification of errors must be made within thirty days, or charges are considered accepted; (6) this agreement shall apply to all current and future charges unless revocation is received by registered mail; (7) credit privileges may be withdrawn at any time without invalidating the terms of this agreement. CREDIT CANNOT BE EXTENDED UNTIL THIS FORM IS COMPLETED AND VERIFIED Authorized signature: ____________________________________________ Title: _______________________________________ Date: ______________________________________