Schultz Communications Application for Credit Date_________________ Name of Business:______________________________________________________________________ Phone: ______________________________ Fax:_________________ Mailing Address:_______________________________________________________________________ City, State, Zip:________________________________________________________________________ Ship to Address: ___________________________________________________Phone:_______________ City, State, Zip_________________________________________________________________________ Type of Business:_______________________________________________________________________ Federal I.D. #:___________________________________D&B #: _____________________________ Number of years in business:_________ Are you? Sole proprietorship:____SSN#:_____________________DL #:___________________________________ Partnerships:_______ Corporation:_______ For Partnerships: Partner:___________________________________________________SSN #:______________________ Mailing Address:____________________________________________Phone: _____________________ City, State, Zip: _________________________________________________________________________ Partner:__________________________________________________SSN #:________________________ Mailing Address:__________________________________________________Phone:________________ City, State, Zip:_________________________________________________________________________ Partner:__________________________________________________SSN #:_______________________ Mailing Address:_______________________________________________Phone:___________________ City, State, Zip:_________________________________________________________________________ Partner:_______________________________________________SSN #:_________________________ Mailing Address:__________________________________________________Phone:_______________ City, State, Zip:________________________________________________________________________ For Corporations: SSN of President or Owner :_________________________________________ State Where Incorporated :_________________________________________ President :__________________________________________ V.P. Finance :__________________________________________ Accounts Payable Supervisor :__________________________________________ Purchasing Agent :__________________________________________ Are P.O.'s required?______________________Are Job Names Required?________________________ What is your anticipated monthly purchase amount?__________________________________________ Are you Tax Exempt?______________If so, please attach an exemption certificate. (All orders will have taxes billed until we have a valid certificate on file) CREDIT REFERENCES: Name:_____________________________________Name:____________________________________________ Address:__________________________________Address:___________________________________________ City, State,Zip:_____________________________City, State, Zip:____________________________________ Phone:_____________________________________Phone:___________________________________________ Fax # :_____________________________________Fax # : ____________________________________________ Account # :_________________________________Account # :_________________________________________ Name:_____________________________________Name:____________________________________________ Address: __________________________________Address:___________________________________________ City, State, Zip:_____________________________City, State, Zip:____________________________________ Phone:_____________________________________Phone:____________________________________________ Fax # :_____________________________________Fax # :____________________________________________ Account #:__________________________________Account #:_________________________________________ Bank Reference: ____________________________________Account #:_________________________________ Address:____________________________________City, State, Zip:____________________________________ Phone:_______________________________________Contact:_________________________________________ Fax:_________________________________________ Bank Reference: ___________________________________Account #:__________________________________ Address:____________________________________City, State, Zip:____________________________________ Phone:_________________________________________Contact:_______________________________________ Fax:_______________________________________________ _____________________________________________________________________________________ CREDIT INFORMATION AUTHORIZATION RELEASE: The information contained herein is for the purpose of purchasing merchandise from Schultz Communications, Inc.. The information disclosed herein is true, accurate and can be relied upon by Schultz Communications, Inc. Applicant hereby authorizes the release of credit and other financial information, including banking information, whether verbal or written, from the entities Applicant has specified in this Application to Schultz Communications, Inc. _____________________________________________________________________________________ _____________________________________________________________________________________ Authorized Signature Title Date The above named Firm hereby makes application for credit and provides the information contained herein, which is warranted to be true and correct, for the purpose of inducing SCHULTZ COMMUNICATIONS, INC. to make periodic sales of goods and equipment to it on credit. In consideration thereof, it is agreed and understood that (1) the undersigned is an authorized agent of the applicant and is duly empowered to enter into and make binding agreements on its behalf; (2) all account balances payable in full within 30 days from date of invoice: (3) a finance charge equal to twelve percent (12%) per annum will be added to delinquent accounts; (4) all payments shall be made to SCHULTZ COMMUNICATIONS, INC. until payment in full has been received; (7) in the event of default of payment when due, all costs of collection, including attorney's fees and court costs, shall be paid by the applicant. APPLICANT _______________________________________ by_____________________________________________ Title____________________________________________ =========================================================================== GUARANTEE OF PAYMENT Dated:_________________________ To:______________________________________________________________and to your agent and/or assignee For value received, the receipt of which is hereby acknowledged, and in consideration of your advancing credit to _________________________, Debtor,_____________________________________________________________________ I/We, the undersigned, hereby personally guarantee the prompt payment to you of all the amounts now due and owing or which may hereafter become due and owing to you from said Debtor entity. Each of the undersigned hereby agrees that the liability for all sums guaranteed shall be a joint and several one. Liability of the undersigned shall not be effected or prejudiced by the additional acceptance of a note or evidence of indebtedness, the extension of time, payment arrangement or other indulgence granted to the Debtor, or by agreement affecting said indebtedness, and the undersigned hereby waives notice of all of the aforesaid. The filing of suit or exhaustion of collection or legal remedies against said Debtor shall not be a condition precedent to the enforcement of this guarantee and the undersigned hereby expressly waive(s) notice of default or non-payment, demand, presentment for payment, protest, notice of protest, or diligence. This Guarantee shall continue until you have received a notice of termination executed by the undersigned. Should the undersigned elect to terminate this guarantee, such termination shall not affect the liability of the undersigned as to accounts and amounts then owing from said debtor. In the event that suit is instituted on this Guarantee, the undersigned hereby agrees to pay all Court costs and such additional sum as the Court made deem reasonable as Attorney's fees. Guarantors agree that this Guarantee is made, entered into and payable at the offices of SCHULTZ COMMUNICATIONS, INC. Guarantors further agree that the liability under this Guarantee shall continue notwithstanding the filing of any petition by the Debtor under any provision of the Bankruptcy Act. __________________________________________________________________________________________________ GUARANTOR __________________________________________________________________________________________________ Residence Address and Residence Phone ___________________________________________________________________________________________________ GUARANTOR _______________________________________________________________________________ Residence Address and Residence Phone Schultz Communications, Inc 701 Gateway Parkway Marble Falls, Tx 78654 830-693-4039 www.eschultz.com Please fax back to: New Accounts @ 830-693-7901.