Gentlemen by gabyion

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									                   Legion furniture                                840 Riverside Parkway, Suite 40, West Sacramento, CA 95605
                   www.legionfurniture.com                         Tel: 916.373.8800 Fax: 916.373.8803


                                                    Application for New Account
Please submit the following information. All information provided to us will be held strictly confidential.

Business Name: ____________________________________ D.B.A.: ______________________ Contact: ________________

Address: _______________________________________________ Phone: ____________________Fax:__________________

__ Corporation / S-Corp       __Limited          __ Proprietorship          __ Partnership            __ LLC          ____Years in Business

Federal Tax ID #________________________                  Resale Permit# _______________________               SSN:___________________

Has the business or any of its principals ever declared bankruptcy?                                 ______ Yes          ______ No

Bank References:

Name___________________________________________                        Fax #_____________________ Tel. # _____________________

Address __________________________________________________________________ Account Number___________________

Name___________________________________________                        Fax #_____________________ Tel. # _____________________

Address __________________________________________________________________ Account Number___________________

Trade References

Name___________________________________________                        Fax #_____________________ Tel. # _____________________

Address __________________________________________________________________ Account Number___________________

Name___________________________________________                        Fax #_____________________ Tel. # _____________________

Address __________________________________________________________________ Account Number___________________

The Applicant authorizes the company to contact the financial, bank and trade references (including those listed herein) and any credit reporting
agencies to obtain/verify credit information;
         promises to pay my/our account in full on or before the due date as defined on the invoice;
         agrees to pay any and all services charges assessed at the rate of 3% per month on past due balances;
         agrees to pay all of the costs and expenses, including but not limited to, third party collection agency fees, attorney’s fees, legal
          expenses, and/or other fees or expenses incurred enforcing any terms of this agreement collecting amounts owed by applicant;
         agrees to notify the Company in writing prior to any changes in ownership, billing address, or authorized buyers;
         agrees that if any term of this agreement is invalid the invalid term shall be considered deleted from the agreement and shall not
          invalidate any other term(s);
         that venue and jurisdiction of any suit or legal action will be in West Sacramento, Sacramento, California;
         that this information has been submitted with the knowledge that it will be used in evaluation the creditworthiness of the applicant for
          obtaining credit or extending additional credit; and
         that the above information is warranted to be true and correct to be the best of applicant’s knowledge.
      My/Our signature(s) below serve(s) as written consent for the company to access personal credit history and/or business credit information
for the purpose of determining my/our credit standing in conjunction with opening a business credit account. The undersigned further aggress
that he/she is an authorized agent on behalf of the applicant and authorized to affix their signature to this agreement.

        PLEASE INCLUDE A COPY OF SELLER’S PERMIT or YOUR CERTIFICATE OF REGISTRATION (SALES TAX).



____________________________                      _______________________________                             _______________
    Signature                                             Print Name / Position                                       Date

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