Dayoub Inc.

Dayoub Marketing Application for Credit (Please print this form and fax to 716-366-8912)
Date ________________		____ Corporation ____ Partnership ____ Proprietorship
Name of Firm _________________________________________ Business Address ____________________________________ Name (s) of Principle (s) ____________________________________ Principle (s) Address ____________________________________________________ Principle (s) SS# ____________________________________ Mailing Address (if different) ____________________________________ Phone # (incl. area code) ____________________________________ Type of Business ____________________________________ Check here if COD sales are OK until credit approved _____ BANKING REFERENCE: Federal ID# _________________ Name and Address of Bank ____________________________________ Name and number of officer familiar with your business ____________________________________ Checking Account# _________________ Loan Account# _________________ TRADE REFERENCES: (excluding credit card accounts) Name Street, City, State, Zip Phone Account# _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ We certify that all information on this form is correct. We understand your credit terms and agree to the proper payment in consideration of extended credit.
		____________________ Your Signature ____________________ Your Title
____________________ Dayoub Approval/Date Should litigation become necessary due to non-performance of payment, the above will be responsible for all costs incurred, and expenses of collection, including legal and attorneys fees, and interest at the rate of 1.5% per month. Venue of litigation will be Chautauqua County, New York or any other location at the option of Dayoub Marketing. It is further agreed that bankruptcy will not forgive the signing parties from amount due on the obligation.