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					                                                                                        COMMERCIAL CREDIT APPLICATION
                                                                                        11 BROAD STREET, NASHUA, NH 03064
                                                                                              PHONE: (603) 889-8144
                                                                                               FAX: (603) 889-7469

                                                           MUST BE FILLED OUT COMPLETELY
COMPANY NAME                                                               DOING BUSINESS AS

BILLING ADDRESS                                                           SHIPPING ADDRESS

CITY                                 STATE           ZIP                  CITY                                STATE            ZIP

PHONE                              FAX                                    BILLING CONTACT

E-MAIL ADDRESS                                                            FEDERAL TAX ID NUMBER



DATE BUSINESS STARTED           LINE OF BUSINESS                                                                     NUMBER OF EMPLOYEES

CHECK ONE
             SOLE PROPRIETORSHIP               PARTNERSHIP              CORPORATION (YEAR INCORPORATED _________________)
HAS THIS BUSINESS OR ITS PRINCIPALS EVER FILED BANKRUPTCY?                WILL A PURCHASE ORDER NUMBER BE REQUIRED?
Yes No
IF YES, WHEN?                         CHAPTER?                                                   YES   NO

                                                   INDIVIDUAL OWNER, PARTNERS OR OFFICERS
NAME / TITLE                                                       SOCIAL SECURITY #                    HOME PHONE #

                                                                                                        (        )
HOME ADDRESS                                                           CITY                             STATE            ZIP

NAME / TITLE                                                       SOCIAL SECURITY #                    HOME PHONE #

                                                                                                        (        )
HOME ADDRESS                                                           CITY                             STATE            ZIP



                                                 COMMERCIAL TRADE REFERENCES (PLEASE LIST 3)
NAME                                     CITY                      STATE        PHONE                           ACCOUNT #
                                                                                (      )
NAME                                     CITY                          STATE           PHONE                    ACCOUNT #
                                                                                       (     )
NAME                                     CITY                          STATE           PHONE                    ACCOUNT #
                                                                                       (     )

                                                                 BANK REFERENCE
NAME                                     CITY                         STATE            PHONE                    ACCOUNT #
                                                                                       (     )


COMMERCIAL CREDIT APPLICATION                                   CONTINUED ON BACK                                                REVISED 4/21/2008
NORTHERN FOREIGN CAR PARTS, INC. COMMERCIAL CREDIT APPLICATION



AGREEMENT
This application is for the purpose of obtaining COMMERCIAL CREDIT and is warranted by Applicant to be
true, correct, and complete in all respects. Northern Foreign Car Parts, Inc. (Company) is hereby authorized to
investigate the references listed, and obtain additional credit information from third parties (including but not
limited to credit reporting agencies).

Upon credit approval, Applicant agrees to payment terms of NET 30 DAYS. Any past due invoice is subject to
a charge of 2% per month (24% annual rate), plus all costs of collection, including but not limited to attorney
fees if collection becomes necessary. All past due accounts will result in orders being shipped C.O.D. pending
account payment to a current basis. Applicant warrants that Applicant is not currently under the jurisdiction of
a bankruptcy court. Applicant agrees to immediately notify Company in writing should Applicant initiate
bankruptcy proceedings, or have any significant change in business operations or ownership.

The below names signatory represents that he/she is an owner, or officer of Applicant, and that he/she is duly
authorized by Applicant to bind Applicant to the terms of this Agreement. In the event that the Applicant
defaults on this Agreement, the signatory to this Agreement represents and warrants that he/she will
be personally responsible and liable for immediate payment in full, upon demand, of all amounts due
including any interest charges and costs of collection.




AUTHORIZED SIGNATURE (FOR APPLICANT)                                      DATE


PRINTED NAME OF SIGNATORY                                                 TITLE




COMMERCIAL CREDIT APPLICATION                                                                        REVISED 4/21/2008

				
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