Address _____________________________________________________________________________________________________

Own _______      Rent _______    Home Phone _____________________________    Work Phone _____________________________

Date of Birth ________________________     SS# _________-_______-__________  Drivers Lic. # ____________________________

Present Employer ______________________________________________________________________________________________

CO-APPLICANT / SPOUSE:

Name _______________________________________________________________________________________________________

Date of Birth ________________________     SS# _________-_______-__________  Drivers Lic. # ____________________________

Present Employer ______________________________________________________   Work Phone ____________________________

Credit terms are net/30 and payment in full is required within 30 days from the delivery date, unless otherwise specified. Late charges will be assessed on any outstanding balance at the rate of 1.5% per month (18% annual). Special pricing given with any plan is void and prices will revert to charge rate, on any delinquent account. 10 day terms for all service work.

NOTICE: The federal equal opportunity act prohibits creditors from discriminating against credit applicants on the basis of sex or marital status. The federal agency which administers compliance with this law concerning this creditor is:

The Equal Credit Opportunity Federal Trade Commission, Washington, D.C. 20500

NOTICE TO CUSTOMERS: DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT IN ITS ENTIRETY.

I (we) state that all information supplied by me (us) is true and accurate & that I (we) have carefully read this application and the credit agreement terms and conditions set forth and unconditionally accept the terms and conditions. Consumer reports (CREDIT REPORTS WILL BE OBTAINED IN CONNECTION WITH THIS APPLICATION), if you request you shall be informed whether or not the reports were obtained and of the names and addresses of the consumer reporting agencies (CREDIT BUREAUS) that furnished the reports. The signer’s bank is authorized to disclose account information in compliance with the credit application.

____________________________________________________________________________________________________________
Applicant Signature                                                                                                                                Date

____________________________________________________________________________________________________________
Co-Applicant Signature                                                                                                                          Date

Completed Credit Applications May Be Faxed To:
1-207-622-7587 - Attention Credit Department