Credit Information Release Form

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					                            THE ELECTROLUX HOME CARE PRODUCTS LTD CREDIT APPLICATION
                                                                             FORM E-3377 (OCT. 01)

                                              Please complete the following application in full and sign in all indicated areas.              We live and
                                       All information supplied in or obtained through this application, will be held as confidential.        breathe clean.


BUSINESS NAME:

BILL TO:                                                                                     SHIP TO (if different):
ADDRESS                                                                                   ADDRESS




CITY, STATE, ZIP                                                                          CITY, STATE, ZIP




BUSINESS PHONE: (                   )                                                        E-MAIL ADDRESS:

FAX NUMBER:             (          )                                                         WEBSITE ADDRESS:

TAX NUMBER:                                                                                  DUNS NUMBER:
E      PROPRIETORSHIP               E CORPORATION                      E PARTNERSHIP
OWNER/PARTNERS/OR OFFICERS
NAME                                                                                      NAME


SOCIAL SECURITY NUMBER                                                                    SOCIAL SECURITY NUMBER


HOME ADDRESS                                                                              HOME ADDRESS


CITY, STATE, ZIP                                                                          CITY, STATE, ZIP


TRADE REFERENCES (MINIMUM 3)
NAME                                                                                      NAME


ADDRESS                                                                                   ADDRESS


CITY, STATE, ZIP                                                                          CITY, STATE, ZIP



PHONE (            )                                                                      PHONE (            )


FAX    (           )                                                                      FAX        (       )
ACCOUNT #                                                                                 ACCOUNT #


NAME                                                                                      NAME


ADDRESS                                                                                   ADDRESS


CITY, STATE, ZIP                                                                          CITY, STATE, ZIP



PHONE (            )                                                                      PHONE (            )


FAX    (           )                                                                      FAX        (       )
ACCOUNT #                                                                                 ACCOUNT #


BANK REFERENCES (MINIMUM 1)
NAME                                                                                      NAME


ADDRESS                                                                                   ADDRESS


CITY, STATE, ZIP                                                                          CITY, STATE, ZIP



PHONE (            )                                                                      PHONE (            )


FAX    (           )                                                                      FAX        (       )
ACCOUNT #                                                                                 ACCOUNT #


CONTACT                                                                                   CONTACT



I hereby acknowledge that the above information is true and correct and hereby authorized the release of any credit information from the above named references
pertaining to my/our credit and financial responsibilities to whom this application is made.
SIGNATURE                                                                            TITLE                                                  DATE
                                       Terms And Conditions
   1)      The above applicant hereby authorizes the Electrolux Home Care Products Ltd. to make inquires as
           are necessary to obtain credit information.
   2)      All due dates on invoices are calculated from the invoice date. Applicant agrees that payments will
           be received at our bank on or before the due date.
   3)      Applicant agrees to pay all invoices according to the prices established by the Electrolux Home
           Products Ltd. and stated on all invoices.
   4)      Applicant agrees to pay the maximum interest rate allowed under applicable
           state law on all past due invoices.
   5)      The financial statements are certified to be true and correct and are submitted in support
           of and as part of the application for credit.
   6)      All merchandise returns must have prior authorization from the Electrolux Home Care Products Ltd
           before being returned.
   7)      The Electrolux Home Care Products Ltd Ltd has the option to charge up to 20% restocking charge,
           unless otherwise stated in writing, on all return merchandise.
   8)      Applicant agrees to take only authorized deductions from payments.




For Office Use Only:


Branch #                                                 Applicant signature

Branch Loc.
                                                         Title
First Order $

Est. Line $                                              Date

Account Type
                       Electrolux Home Care Products LTD
                        Bank Release Authorization Form

Dear Sir/Madam:

An opportunity to conduct business with the below referenced business has been presented to
us. This organization has listed you as a banking reference.

We would appreciate you taking a moment of your time to complete the bottom section of this
letter so that we can ascertain this potential customer’s ability to satisfy its trade obligation with
us. Any information you provide will be maintained in the strictest of confidence. Please note
your customer has signed this letter as a release form.

Sincerely,


Diana Woodring/Financial Operation Specialist
Electrolux Home Care Products LTD/Credit Department

I GIVE MY CONSENT TO MY BANK TO RELEASE THE INFORMATION BELOW TO
THE ELECTROLUX HOME CARE PRODUCTS LTD COMPANY

Customer Signature________________________ Bank Account Number_______________
Business Name      __________________________ Bank Name      ___________________
Business Address __________________________
                      __________________________


Information below to be completed by bank
Checking:                                               Loans:
Date Opened___________________                          Secured/Unsecured__________________

Average Balance________________                         High Credit________________________

Account Rating_________________                         Balance___________________________

NSF__________________________                           Payment Performance________________

Savings:                                                Comments:
Date Opened___________________

Average Balance________________
gation with

				
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