APPLICATION FOR CREDIT

EARTH SUN MOON TRADING COMPANY, LLC
APPLICATION FOR CREDIT

Business Name: ____________________________________________ Bus. Phone: _______________________________
DBA: ____________________________________________________ Fax No.: __________________________________
Billing Address: ____________________________________________ Resale No.: _______________________
City:______________________________ State:_______ Zip: ______________ Email:_____________________________

LIST NAME(S) AND TITLE(S) OF CORPORATE OFFICERS, PARTNERS, OR OWNERS
Name/Title Home Address/Zip Code

1. __________________________________________________________________________________________________

2. __________________________________________________________________________________________________

BUSINESS INFORMATION
Business Start Date: ____________________________________ No. Years at Present Address: ______________________
Entity (circle): sole proprietorship partnership corporation "S" corporation non-profit other: __________________
Type of Business:______________________________________ Credit Line Requested: ____________________________
Accounts Payable Contact:_______________________________ AP Phone No.: __________________________________
Accounts Payable Email: ________________________________ Do you wish to receive invoices electronically? □ Yes □ No

TRADE REFERENCES
Name Address/Zip Code Phone Fax

1. __________________________________________________________________________________________________

2. __________________________________________________________________________________________________

3. __________________________________________________________________________________________________

4. __________________________________________________________________________________________________

BANK REFERENCE
Name/Branch Address/Zip Code Acct # Acct Type

1. __________________________________________________________________________________________________

Individual at Bank Whom We May Contact _______________________________ Contact Phone: ____________________

PAYMENT TERMS - 1% 10, NET 30
A late charge of 1.5% per month (18% per annum) will be charged on delinquent balances.
Failure to pay within terms may result in loss of credit terms.
I certify that all the information on this application is correct and that I fully understand your credit terms and agree to the proper payment in consideration of credit extended.
I authorize Earth Sun Moon Trading Company, LLC to contact all references listed on this form for the sole purpose of obtaining information to assist them in determining my creditworthiness.
This agreement includes the terms and conditions titled "Earth Sun Moon Terms" below.
I also certify that I am authorized to bind my organization to this agreement.

X___________________________________________________________________________________
SIGNATURE TITLE

EARTH SUN MOON TERMS

Both parties agree that a facsimile copy of this document will be considered to be an original.

A $30 fee will be charged for all checks returned for non-sufficient funds or any other reason.

In the event of a breach of any of the terms of this agreement between Purchaser and Supplier, including but not expressly limited to the failure to pay sums owed to the Supplier when due,
the Purchaser agrees to pay the reasonable attorney fees incurred by the Supplier in the enforcement of Supplier’s rights even though no suit or action is filed.
In the event that suit is brought to enforce any part of the terms of sale herein, venue will be in Mercer County, Pennsylvania.

FAX APPLICATION BACK TO 724-605-2983 OR MAIL TO 111 NORTH CENTER STREET, GROVE CITY, PA 16127 ATTN: CREDIT DEPT.