Fill and Sign the Your World Timesheet Form

•3420 Kenilworth Ave., Bladensburg, MD 20710 NATIONAL CAPITAL INDUSTRIES® (301) 864-4150 •2801-A W. Patapsco Ave, Baltimore, MD 21230 (410) 644-0300 •8433A Backlick Road., Lorton, VA 22079 (703) 339-0909 WHEN COMPLETED PLEASE RETURN FAX TO: 301-985-3193 CREDIT APPLICATION AND AGGREEMENT DATE: FIRM NAME: PHONE: STREET ADDRESS: PO BOX: FAX#:__________________________ CITY STATE ZIP CODE E-MAIL:________________________ TYPE OF BUSINESS:____CORP. ___ PARTNERSHIP____INDIVIDUAL YEAR ESTABLISHED:__________ CREDIT $ DESIRED_________________ PURCHASE ORDERS:___Y ___N ___WRITTEN___ VERBAL___ BOTH TAX EXEMPT:___Y___N IF YES PLEASE FURNISH AN EXEMPT CERT. PRINCIPALS & TITLES: BANK NAME AND ADDRESS: ACCOUNT # PHONE #: _______________________________________________ Name of Predecessor Businesses: ______________________________________________________________________________________ Have any of the companies or individuals listed above ever been a debtor in a bankruptcy proceeding? _______________________________ Has any judgment ever been entered against any of the companies or individuals listed above? _____________________________________ Are they’re any legal actions or arbitration’s pending against any of the companies or individuals listed above? ________________________ TRADE REFERENCES (OPEN ACCOUNTS ONLY) NAME Account # ______________Phone #________________Fax #___________________ Address: _______________________________________________________________Contact Name: _____________________________ Name ____________________________________Account # ______________Phone # _______________Fax #___________________ Address: ________________________________________________________________Contact Name: ____________________________ Name ____________________________________Account #_______________Phone # _______________Fax #___________________ Address: ________________________________________________________________Contact Name: ____________________________ Name ____________________________________Account # ______________Phone # _______________Fax #____________________ Address: _______________________________________________________________Contact Name: ______________________________ DELIVERY OF MY INVOICE SHOULD BE SENT TO: †e-mail or † fax PLEASE CHECK ONE _______________________________________________ ENTER e-MAIL OR FAX NUMBER HERE I.WE hereby certify that the above information, given for the purpose of obtaining credit, is true and correct, and I/WE authorize you to obtain such information as you may require concerning this application and agree that it remain your property whether or not credit is granted. I/WE also understand that a SERVICE CHARGE computed by a periodic rate of 1 ½% per month will be applied to all accounts 60 days and older, which equals18% per anum, plus attorney’s fees of 25% in the event of the account is placed with an attorney for collection. FIRM NAME DATE BY: SIGNATURE AND TITLE GUARANTY given by the undersigned to National Capital Industries®, Inc., herinafter called National Capital, to induce it to extend credit to Herinafter called the customer. The undersigned hereby guarantees the prompt payment, when due, of the full amount indebtedness owing by the customer to National Capital, including interest provided under this guaranty. The undersigned’s liability hereunder shall not be affected by extension of time, renewal, or change in the form of the customer’s indebtedness hereby guaranteed. In Witness Whereof, each of the undersigned has hereunto set his hand & seal this day of Witness ,20 . Signed By GUARANTEE OF PAYMENT OF ACCOUNT FOR GOODS SOLD & SERVICES RENDERED TO CORPORATION OR PARTNERSHIP. In consideration if supplying goods, merchandise, equipment, & services upon credit to from time to time determine, we the undersigned jointly & severally guarantee to Of you, your successors, & assigns, the due & punctual payment of such sums of money as to any time & from any time shall be owed to you by for we further agree jointly & severally that in case National Capital Industries®, Inc. shall bring suit to compel performance of or recover for breach of this agreement reasonable attorney’s fee amounting to 25% of the outstanding monies due on account in addition to the amount of the judgement & cost including the costs of service of process & service charge computed by a periodic rate of 1 ½% per month which will be applied to all accounts 60 days & older, which equals 18% per anum. GUARANTORS Name Name Address Address City State Zip City Phone # Phone # Social Security # Social Security # Signature Date State Signature Zip Date *****************************************FOR NCI USE ONLY********************************************* Credit Limit Customer # Sales Code Business Code Approved Date Price Code Declined Date