PRO-MATE (BUSINESS)

BUSINESS BACKGROUND

APPLICANT'S NAME	TEL:	FAX:
BUSINESS NAME, IF DIFFERENT FROM ABOVE:		E-MAIL:
BILLING ADDRESS:	CITY:	STATE: ZIPCODE:
SHIPPING ADDRESS:	CITY:	STATE: ZIPCODE:

NUMBER OF LOCATIONS:

PLEASE LIST ADDRESS, AND ADVISE IF INDIVIDUAL ACCOUNT
NUMBERS OR INDIVIDUAL DROP SHIP DESIRED

TYPE OF BUSINESS:
SOLE PROPRIETORSHIP() PARTNERSHIP() CORPORATION()

ESTABLISHED IN STATE OF:

YEAR BUSINESS ESTABLISHED:

NO. OF YEARS IN BUSINESS:
YEAR(S)

OWNER'S NAME:

NAME OF OFFICER, IF INCORPORATED:

TITLE:

STATE SALES TAX ID #:

A/P CONTACT:

SOCIAL SECURITY NUMBER:

FEDERAL TAX ID #

BANK REFERENCES

NAME OF BANK:	TEL:	FAX:
ADDRESS	CITY	STATE: ZIP CODE:

ACCOUNT(#1) NO:

TYPE OF ACCOUNT:

ACCOUNT(#2) NO:

TYPE OF ACCOUNT:

TRADE REFERENCES (ONE OF THE REFERENCES MUST BE A BEAUTY PRODUCTS SUPPLIER.)

NAME OF VENDOR(#1):	TEL:	FAX:
ADDRESS	CITY:	STATE: ZIP CODE:
NAME OF VENDOR(#2):	TEL:	FAX:
ADDRESS	CITY:	STATE: ZIP CODE:
NAME OF VENDOR(#3):	TEL:	FAX:
ADDRESS	CITY:	STATE: ZIP CODE:

Invoice will be billed with MONTHLY STATEMENT by billing cycle on every 25th day of the month for the orders made and processed through 24th day of each month. Undersigned agrees to pay full balance appearing on the MONTHLY STATEMENT within 10 days. 1.5% monthly interest may be charged on all past due invoices. Undersigned is responsible for all collection costs should his or her account be reffered to a third party. A $25 charge will be applied for each returned check. I hereby authorize Pro-Mate to use the information provided here to contact the sources listed above to verify all the necessary information for the credit approval processes.

OWNER'S(OFFICER'S OF CORP.) SIGNATURE(INITIAL)

DATE SIGNED