PLEASE NOTE: We must have an application on file even it you are requesting CASH terms. All information must be completed. PALECEK DATE / / Telephone (800) 274-7730 • FAX (510) 236-0561 REP NAME: REQUESTEDTERM NOO Prepaid info 4a)palecok.com CREDIT APPLICATION Mono print or typo ( ) COMPANY NAME PHONE ( ) COMPANY WOMAN: FURNITURE BUYER FAX ACCESSORY BUYER EMAIL GUANO ADDRESS CITY %., STATE ZIP SHIPPING NAME ANDADDRESS OF DIFFERENT THAN ABOVE) SHHPP01G NAME STREET CITY STATE ZIP Ownw(s) Address AP Canted Phone How tong In (WOWS 0-S morals I2 moats 1.2 years 2.5 yeast Over S yews Under your a:ramble Type of f3uPriess? Corp Parinership Sao Propeetoahlp Federal I D e Dun & &Mine? I O Architect O Designer Showroom K Hotelifiesteurant o Wholesale PLEASE CHECK THE BOX NEAREST TO DESCRIBING YOUR BUSINESS O Contract Specifier O Floral O Lifealykr O One lime Buyer O Oecorative Accessory O Fumlure O Malt Order O Grocery O Department Stow o GlIVStationery O Mass Merchant O Store with Designer o Designer O Newt O Nursery O Other is O Under STOOK O $100K $200K ESTIMATED ANNUAL RETAIL VOLUME K $201K - WOK O $401K • S000K EFTA00308077