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					                                                                               Entire application must be completed in full for approval

                                           MARTIGNETTI COMPANIES
                                                  CREDIT APPLICATION

    Name on License ______________________________________________________d/b/a __________________________________________
    Street Address ______________________________________________________________________________________________________
    City _______________________________________________________ State___________________________ Zip ____________________
    Phone# _________________________________ Fax# __________________________________ Contact _____________________________

2. TYPE OF BUSINESS (check one):  Sole Proprietor  Partnership  Corporation  S Corp.  LLC
                                                                                   Years of business under present ownership: __/__
    Does Licensee own another Liquor License?   Yes       No
      If yes: Name(s) and location(s)______________________________________________________________________________________

3. PRINCIPALS (Sole Proprietor or Partnership only) SSN: _____-____-______
    Name _________________________________________________________________________ Phone ______________________________
    Home Address _____________________________________________ City _________________ State ___________ Zip ________________
    Name _________________________________________________________________________ Phone ______________________________
    Home Address _____________________________________________ City _________________ State ___________ Zip ________________

4. OFFICERS (Corporation or LLC only) FID #: _____________________________________
    President _______________________________________________ Vice President _______________________________________________
    Treasurer _______________________________________________ Secretary ___________________________________________________

5. LICENSE INFORMATION: License No.____________________ Date Issued _________________  New  Transfer
                                    If transferred, from whom? ____________________________________________________________
    License Type:  On-premise  Off-premise  All Alcoholic Beverage  Wine/ Malt Only  Wine/Malt/Cordial Non-Alcoholic


I hereby certify that all statements accompanying and contained in this credit application are true and correct, and made for the
express purpose of obtaining credit. I hereby authorize the parties named above to release credit information to the Seller for the
purpose of conducting a credit investigation. In consideration of selling to me or my agent(s), I hereby agree to the following terms:
     (1) To promptly pay all invoices in full in accordance with the terms of sale, which are net 45 days from delivery, unless
         otherwise agreed to by both parties in writing.
     (2) To pay a service charge for late payment, computed at an annual percentage rate of 18% (1.5% per month) on any unpaid
         balance 30 days or more past due.
     (3) To pay a service charge of $25.00 for each check returned by a bank for insufficient funds.
     (4) To pay all costs and reasonable attorney’s fees in the event that this account is forwarded to an attorney for collection.
     (5) The undersigned is authorized to accept these terms and conditions on behalf of the Company named below.

                                          EXECUTED AS A SEALED INSTRUMENT

Company Name ________________________________________________ E-Mail _____________________________________

By ______________________________________________________ Title _______________________ Date _________________
            Owner / Officer

                                       975 University Avenue Norwood, MA 02062
                                 800-USA-WINE • Phone 781-278-2000 • Fax 781-278-2079

                                                                               Entire application must be completed in full for approval

                               Name                              Telephone /Bank Officer                           Account Number

                               Address – Street                         City                      State                     Zip

                               1)     Name

                               Address – Street                         City                      State                     Zip

                               2)     Name

                               Address – Street                         City                      State                      Zip

Please list only accounts in
 which you have current        3)     Name
     open credit terms
                               Address – Street                         City                      State                      Zip

To be completed by Sales:

Sales Rep #_________

Credit Limit Requested:             $_____________________

Estimated amount of first order:    $_____________________

Estimated monthly orders:           $_____________________

If this account is part of a Chain – Chain #_______

Other pertinent information that will assist Credit in approving the account and establishing an appropriate credit limit:

                                            975 University Avenue Norwood, MA 02062
                                      800-USA-WINE • Phone 781-278-2000 • Fax 781-278-2079

Please complete the top portion of the following reference request and return with your completed Credit


Bank Authorization:

Attn: ____________________________________________________________________________________
Address: _________________________________________________________________________________
        Street                                                  City/Town                                   Zip

Phone #______________________________________ Fax# ______________________________________

Attn Bank Personnel:

For the purpose of establishing an open account with Martignetti companies, we hereby authorize you to release information on our
checking account.

Our Account Number is: _________________________
Company Name: _________________________________________
Authorized Signer: _______________________________________
Date: __________________________________________________

Martignetti Companies will have your Bank complete the following.

In order that we may consider granting open account terms to the customer, we ask you, in confidence, to supply us with the
following information. We accept response by fax (781) 278-2079 or mail to the address below, Attn: Credit Department

Checking Account: #____________________________________
Opened: ______________________________________________
Average Balance: _______________________________________
NSF Checks: Yes           No
Other Comments: _______________________________________________________________________________________

Information provided by: _______________________________                       Date: _____________________

Thank you for your cooperation,

Martignetti Companies

                            Carolina Wine & Spirits • Silenus Wines • Gilman Wine & Spirits • Classic Wine Imports
                        Martignetti Companies of New Hampshire, Vermont & Rhode Island • Maine Beverage Company
                               975 University Avenue • Norwood, MA 02062-2643 • Ph: 781-278-2000

                                    MARTIGNETTI COMPANIES
                                          CREDIT APPLICATION


To induce the Martignetti Companies, or any of them, to sell merchandise and extend credit to ___________
    (Exact Name of Licensee)

of ___________________________________________________, _____________________, ________ the
      (Address of Licensee)                                          City/Town                    Zip

 undersigned hereby jointly and severally guarantee the payment of any indebtedness and other financial
obligations which may at any time and from time to time be incurred by the said licensee to any of the
Martignetti Companies; and in the event of any default at any time by the said _________________________
                                                                                        Name of Licensee

You shall be entitled to look to us immediately for such payment and satisfaction of other financial
obligations, without prior demand or notice.

This guaranty shall continue in full force and effect until such time as the Martignetti Companies has received
written notice of revocation from the undersigned at its business offices, 975 University Avenue, Norwood,
Massachusetts 02062. Such notice of revocation shall be ineffective as to any existing indebtedness and
financial obligations otherwise included in this guaranty.

If this guaranty is forwarded to an attorney for enforcement, the undersigned shall pay all reasonable costs of
enforcement, including court costs and reasonable attorneys’ fees.

Notice of your acceptance or reliance on this guaranty is waived. This is an absolute guaranty and Martignetti
Companies shall not be required to pursue any legal or equitable remedy against ________________________
                                                                                    Exact Name of Licensee

before enforcing it.

Executed as a sealed instrument:                                    ___________________________________
                                                                                     ,Guarantor (Individual)

                                      Residential Address: _________________________________________

Date: _________________________