Credit Terms Application

COMPANY DETAILS

Company Name*

DBA (if applicable)

Federal Tax EIN*

Store Phone*

Fax

Company Type*

Proprietorship
Patrnership
Corporation / LLC

Number of Years in Business*

Date Established*

Principal*

First Last

Principal Email*

Address*

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

Parent (if applicable)

Parent Email

Address

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

Has the firm or any of its principals ever filed for bankruptcy*

No
Yes

Please explain the situation surrounding the bankruptcy*

BILL TO

Accounts Payable Name*

Account Payable Email*

Billing Address*

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

Preferred Terms*

Net 30
Credit Card
Pre-Paid
COD

Note: Final Terms to be reviewed and approved by credit team

SHIP TO

Name*

Phone*

Address*

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

BANK REFERENCE

Bank Name*

Checking Account #*

Loan Account #

Bank Address

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

Contact Name*

First Last

Bank Phone*

Bank Fax

TRADE REFERENCES

1. Trade Reference*

Contact Name*

Account #*

Fax

Email*

2. Trade Reference*

Contact Name*

Account #*

Fax

Email*

3. Trade Reference*

Contact Name*

Account #*

Fax

Email*

Terms and Conditions*

For the purpose of inducing Genexus International, Inc. to extend credit, each individual signatory hereto represents that the information herein has been personally verified and is true and correct in all aspects; the applicant has sufficient assets to satisfy all anticipated liabilities, and Genexus International, Inc. will be notified in writing of any actual or suspected tangible changes in the financial condition of the applicant. Furthermore, in consideration for the benefits which may accrue to the individual signatories hereto by Genexus International, Inc. extension of credit to the applicant, each individual signatory irrevocably agrees to serve as the absolute and unconditional guarantor and surety for all obligations and liabilities of the applicant incurred from the date of the signature hereto, notwithstanding any extension, forbearance or modification of the same. It is also agreed that the applicant (and the individual signatories as guarantors and sureties) shall be liable for all costs, expenses and attorney’s fees incurred by Genexus International, Inc. in connection with this account, and its authorized agent, are hereby authorized to make inquiries as it deems fit and proper regarding applicants credit history, including but not limited to inquiries directed to those references identified in this application. I authorize the noted bank reference to release all information on the listed account(s) to GENEXUS INTERNATIONAL, INC for the purpose of establishing credit terms with them. If you are purchasing bobi or bobiBLACK products with a credit card, you agree that, upon Genexus International, Inc acceptance of your order, Genexus International, Inc may charge your credit card for the full cost of your order plus shipping. You further agree that risk of loss on products you order will shift to you upon Genexus International, Inc delivery of those products to a carrier at Genexus International, Inc distribution or fulfillment center, and that you will pay shipping costs from Genexus International, Inc distribution or fulfillment center to you.

I agree to the Terms and Conditions

Principal's Signature*

Date*

COMPANY DETAILS

BILL TO

SHIP TO

BANK REFERENCE

TRADE REFERENCES