FOOD SERVICE TECHNOLOGIES

710 Chestnut Street Lebanon, PA 17042 PHONE: 717-228-0300 FAX: 717-228-0500 www.my4points.com

_________________________________________________________________ ALL INFORMATION MUST BE FILLED OUT ENTIRELY Name of Applicant:___________________________________ Position___________________ Business Name:________________________________________________________________ Billing Address:________________________________________________________________ City:___________________ State:___________ Zip:_________ County:___________________ Shipping Address: _______________________________________________________ same as billing City:___________________ State:___________ Zip:_________ County:___________________ Phone:____________________ Fax:____________________ Email:______________________ Nature of Business________________________________ In Business Since_______________ Accounts Payable Representative:_____________________ Phone:______________________ Type of Business: Sole Proprietorship Partnership Corporation Government Tax Exempt? No Yes-Exemption Certicate #_________. Please attach copy Purchase Order or Job Name required for payment? No PO Job Name TRADE REFERENCES

4 POINTS CREDIT APPLICATION

COMPANY NAME

CITY

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ADDRESS

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FAX

COMPANY NAME

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COMPANY NAME

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FINANCE REFERENCES
BANK NAME BANK NAME

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CONTACT

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Return via fax(717-228-0500) or email(accounts@my4points.com)

NAMES OF OFFICERS, STOCKHOLDERS, OR OWNER(S)

NAME ADDRESS CITY

POSITION

PHONE

STATE

ZIP

SOCIAL SECURITY #

NAME

POSITION

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ADDRESS

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SOCIAL SECURITY #

NAME

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NAME

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We, the applicant, represent and warrant the following information is correct and complete, and understand that said information would be relied upon in granting an extension of credit to the undersigned. We authorize 4 Points to verify such information with credit reports and inquiries with any and all persons or rms with whom we have had business dealings. We Authorize our bank(s) noted above to release to you any information about us available to them to assist you in processing a line of credit for us. Signature:______________________________________________________Date:_______________________
TERMS: Payment. If credit is extended to the Client, payment of the full amount due from Client for the services and materials provided to Client is due no later than 30 days after the invoice date. A monthly charge of two percent (2%) of the balance due shall be added to any amount unpaid thirty (30) days after the invoice date. The undersigned waives notice of maturity, demand, presentment for payments, notice of non-payment and protest, and further agrees to pay reasonable attorneys fees (25% of the amount due) and all costs of collection should it become necessary to place this agreement in the hands of an attorney (regardless of whether a lawsuit is led) for collection or to protect the interest of 4 Points, its agents, employees, subcontractors and aliated companies. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Pennsylvania, without regard to principles of conicts of law. The parties hereby irrevocably submit to the jurisdiction of the courts of the State of Pennsylvania, with venue in Lebanon County, over any dispute arising out of this Agreement and agree that all claims in respect of such dispute or proceeding shall be heard and determined in such court. The parties hereby irrevocably waive, to the fullest extent permitted by applicable law, any objection which they may have to the venue of any such dispute brought in such court or any defense of inconvenient forum for the maintenance of such dispute. Severability. The invalidity or unenforceability in whole or in part of any covenant, promise or undertaking, or any section, subsection, sentence, clause, phrase, word, or any of the provisions of this agreement will not aect the validity or enforceability of the remaining portions of this agreement. Entire Agreement. This Agreement contains the complete understanding of the parties hereto concerning the contract interpreting arrangement and shall, as of the eective date of this Agreement, supersede all other agreements between the parties. Both parties agree that all prior agreements, if any, between the parties, whether oral or written, are hereby revoked, terminated and/or superseded by this Agreement. I/We agree to the above terms.

Signature:______________________________________________________Date:_______________________

SIGNATURES REQUIRED:

Signature Title Printed Name Date Two corporate ocers __________________________________________________________________ All partners __________________________________________________________________ All co-partners __________________________________________________________________ Individual Owners & Spouses__________________________________________________________________
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