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CREDIT APPLICATION PURCHASE AGREEMENT

CREDIT APPLICATION PURCHASE AGREEMENTP hone: 1-866-412-6726 Fax: 1-800-436-9192 Email: APPLICANT S BUSINESS TYPE:nRetailnTransportationnVeterinarynW holesale DistributionnOther FacilitiesnAmusement & Entertainment nBuilding Service ContractornCash and InternalnCorrectional FacilitiesnEducation Pre K-12nHealth and FitnessnHealthcare AcutenHealthcare Long TermnLodging & HospitalitynManufacturing & UtilitiesnMultifamilynNot-for-ProfitnPro perty Management Commercialn Property Management Shopping MallsnPlace of WorshipnEducation Colleges, Univ, TechnFederal Government AgenciesnFood ProcessingnFood Service & Drinking PlacesnGovernment State and LocalINTERNAL USE:Sales Representative: _____Sales Representative ID: _____APPLICANT:Name: _____Address: _____ City/State: _____ Zip: _____Billing Address: _____ City/State: _____ Zip: _____Purchasing Contact: _____ Phone: _____ Fax: _____Purchasing Contact E-Mail Address: _____ No.

you agree that by requesting credit, submitting a credit application, receiving credit, or entering into a commercial relationship with the company, you waive your right to participate in a class action, private attorney general action or other representative action against the company and its affiliates in a court or in arbitration, as applicable.

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