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BusinessName___________________________________ShippingAddress_________________________________________MailingAddress____________________________________________________________________________City_____________________________________________E-mail__________________________________________________State______________Zip_______________________Contact_________________________________________________Telephone_______________________________________Fax____________________________________________________MultiJurisdictionSalesTaxExemptionCertificateIncompliancewithSalesandUseTaxLawsitisnecessarythatwereceivethiscerti2cateforanytypeofaccountOpenBillingCreditCardorCODifthemerchandiseispurchasedforresalecompletewithyourStateTaxIDNumber.StateTaxIDNumber________________________________2.AccountInformationWeofferthreetypesofaccounts.PleasechoosethetypeofaccountyouarerequestingqOpenBillingqCreditCardqCODextrachargesapplyifdifferentOpenCreditApplicationIfyouwouldliketobeconsideredforopenaccountbillingprivilegesplease2lloutthefollowingcreditinformation.ThissectionisnotnecessaryforcreditcardorCODaccounts.TermsareNet10th.Statementsaregeneratedonthelastdayofthemonthdueandpayablebythe10thofthefollowingmonth.Servicechargeswillbeassessedonpastdueaccounts2ofunpaidbalanceorminimum2.00.ShipmentswillbeCODorpre-payonaccountswithpastduebalances.Bysigningbelowyouagreetoourtermsandconditionsforopenbillingprivilegesandagreetopayalllegalandcollectioncostsassociatedwithpastdueamounts.AuthorizedSignatureTitleDateBusinessNameAddressCityStateZipTelephoneFaxYourAccountWithListedSupplier1.BusinessNameAddressCityStateZipTelephoneFaxYourAccountWithListedSupplierBankReferenceBankNameAddressCityStateZipTelephoneFax3.BusinessNameAddressCityStateZipTelephoneFaxYourAccountWithListedSupplierPrincipalSuppliers__________________________________________________________________________________________________________AuthorizedSignatureTitleDate