FurnitureBrands Credit Application Return Application via FAX (828) 438-5213 or email to DEALER INFORMATION REQUESTED CREDIT AMOUNTS ■ Cash Before Delivery Legal Name: Trade Name(s): Former Legal or Trade Name(s), if any: Type of Organization: ■ C Corp ■ S Corp ■ Gen. Pan. K Ltd. Part. ■ Proprietorship ■ LLC ■ Other: County and State Organized: Year Organized: Tax ID # or FEIN If sole proprietorship, SS#: Date of Birth: Billing Address: Ship To Address: Telephone #: Fax #: Email: Requested Brand: Major Brands Carried: Est. Brand Annual Sales: Initial Order Amt: Are you a current or former Furniture Brands customer? K Yes K No Brand & Account # Sales Rep: Sales Rep Phone # Type of Store: K Gallery K Designer K Branded Store Sq Ft. ■ Contract K Full-Line K Authorized Dealer Other Are there any suits, liens or judgments over $50,000 filed against Applicant, and/or has Applicant or Owner(s) ever filed for bankruptcy? K Yes K No if yes attach explanation RELATED PARTIES or ADDITIONAL LOCATIONS (include additional sheet if necessary) Name Street City State Lp Type of Location Own/Rent (Store, Ship To, Warehouse) OWNERSHIP (include additional sheet if necessary) Name Position Years w/ Years Industry Email Address Phone It % of Ownership Business Experience KEY PEOPLE (include additional sheet if necessary) Name Position Years w/ Years Industry Email Address Phone it Fax It Business Experience A/P Manager General Manager Finance Contact Claims Contact Buyer(s) BANKING & CREDITOR REFERENCE INFORMATION (include additional sheet if necessary) Name City State Account li Contact Person Phone it Fax ti ADDITIONAL INFORMATION (check if included) K Year-End Financial Statements (2 years) or Federal Tax Returns (2 years) K Resale Certificate K Distribution Agreement Agreement and Disclosures: EFTA00521645