Accent USA, Inc.


Application for Credit

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Date: Fed. ID# State Sales Tax #

Owner / Principal: State Driver's License #

Firm Name: Phone: Fax:

Street: City: State: Zip:

Billing: City: State: Zip:

Incorporated / Year: City: State: Zip:

Trade References
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Name: Phone: Fax:

Street: City: State: Zip:

Name: Phone: Fax:

Street: City: State: Zip:

Name: Phone: Fax:

Street: City: State: Zip:

Name: Phone: Fax:

Street: City: State: Zip:

Name: Phone: Fax:

Street: City: State: Zip:

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Please read the following carefully

I hereby agree to pay all collection costs, attorney's fees and court costs if collection procedures become necessary. I further agree to pay all invoices on purchases (charges) made by me or our designated buyer. I fully understand that if the charges remain unpaid for a period of 30 days or more beyond the date of invoice (unless otherwise stated on the original sales order) interest will accrue at the rate of 1.5% per month on any unpaid balance. I further assume responsibility for all of the above mentioned fees applied to the unpaid balance.
This agreement shall be governed by and construed in accordance with the laws of the state Colorado. Exclusive venue for any disputes hereunder, shall be in Chaffee County, state of Colorado.

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Owner / Principle: Designated Buyer:

Date: I hereby agree to the above mentioned terms