1804 NW Martin Road ~ Forest Grove, OR ~ Phone: (503) ~~ Fax: (503) or

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1 1804 NW Martin Road ~ Forest Grove, OR ~ Phone: (503) ~~ Fax: (503) or NET 30 NEW ACCOUNT APPLICATION Please, complete all Forms. Failure to do so will delay the processing of your application or will result in your account being set up as a COD ACCOUNT automatically. Company s Name Shipping Address Billing Address Telephone # ( ) Fax Number # ( ) Address Applicant Name Applicant Phone # Name of Primary Contact Title Name of Second Contact Title Name of Accounts Payable Contact AP address: AP Phone number (if different) Type of Ownership: Individual: Partnership Corporation If Incorporated, in what state Date of Incorporation Type of Business Wholesale ( ) If different, please specify *If possible, please include a copy of your business license. Federal Tax ID Number # *How would you like to pay? Credit-Card (Visa/Master Card/Discover/AMX) Cashier s Check Wire Transfer/ACH or Company Check The names of all persons owning or controlling interest in the applicant are as follows: Name Address Title Home Phone # SS#

2 BLANKET AUTHORITY TO USE CREDIT CARD This authorizes Oregon Roses, Inc. to use: ( ) Visa ( ) Master Card ( ) Discover ( ) American Express For Payment on any COD or Credit Card shipment unless notified by customer and other payment arrangements are made in advance of shipment, any check returned NSF and $25.00 NSF charge, or in the event of any unpaid invoices 45 days or older not subject to a reimbursement claim or dispute previously documented in writing. Cardholders Name Company Name Card Number Expiration Date Card Address V-Code (3 digit #) *Oregon Roses, Inc., will notify you in writing of any amount that is debited from your credit card. I have read and understand the terms of this agreement and will abide by its terms. Signature of Cardholder Print Name Date *This form must be completed and faxed prior to shipment to Oregon Roses, Inc., at (503) or (503) or mail to 1804 NW Martin Rd. Forest Grove, OR Failure to do so will delay the processing of your application. (Confidential)

3 References I hereby authorize any of the references listed hereon to provide Oregon Roses, Inc., with any and all information requested. Signed Print Name Title Credit Company Name : Contact Person : Address : (Street number and Address) (City) (State) (Zip) Phone Number : Address: Fax Number : Years of doing business: Company Name : Contact Person : Address : (Street number and Address) (City) (State) (Zip) Phone Number : Address: Fax Number : Years of doing business: Company Name : Contact Person : Address : (Street number and Address) (City) (State) (Zip) Phone Number : Address:

4 Fax Number : Years of doing business: Banking: Please provide one banking reference: Bank Name : Account #: Contact Person: Address : Phone Number : Fax Number: The Federal Communications Commission (FCC) issued a new interpretation of the Telephone Consumer Protection Act of 1991 that prohibits sending unsolicited faxes without prior written consent. As of August 25, 2003, you cannot fax anything to your customer and prospects unless you have signed written permission. COMMUNICATIONS CONSENT FORM Name: Company: Address: City State Zip Telephone: ( ) Fax: ( ) I understand that by providing my mailing address, address telephone number and fax number, I consent to receive communications sent by or on behalf of Oregon Roses, Inc., via regular mail, telephone, fax or . I also understand that Oregon Roses, Inc. will not share the provided information with others.

5 Signature Your Title: Date: OREGON ROSES CREDIT APPLICATION AGREEMENT The undersigned hereby agrees and covenants that the information in this application is true and correct as of the date of this application. The undersigned agrees to notify Oregon Roses, Inc., hereafter referred to as ORI on or before the date any information contained in this application becomes incorrect. This credit application shall become binding and effective on the date the undersigned is notified by ORI that the credit application has been approved and an open account has been established of use. The applicant wishes to purchase product from ORI in the future and wishes to open account with ORI according to the terms and conditions contained herein and noted below: 1. Until credit has been established, all orders must be processed in one of three ways: CREDIT CARD prior to shipment (Fill out credit card authority form) COD via cashier s check, or company check (This means the freight carrier MUST accept COD shipments, or the order MUST be prepaid) WIRE transfer or funds 2. To establish credit, complete this credit application. After analyzing credit information received, including reference information, (please allow 1-2 weeks for processing), we will inform you regarding the terms that will be applied to your account including a credit limit if applicable. Our standard terms require payment in full by the 25 th of the month following the

6 month of purchase. A service charge of 1.5 % per month (18% annually) will be assessed on all accounts over 30 days old. 3. Accounts over 60 days will be considered delinquent and are subject to COD and holds on future orders. If it becomes necessary for Oregon Roses, Inc., to institute legal action to enforce collection of any amounts due, Oregon Roses, Inc., shall be entitled to reasonable attorney s fees, court cost, and costs of collection at debtor s expense. The applicant understands and agrees that all billing, accounts and credit functions, and all other business functions are maintained and carried on in Washington County, Oregon. In the event of suit or any dispute about products or services supplied under this agreement, such shall take place in Washington County, Oregon. I have read, understand, and accept the above terms, and have provided true information to the best of my knowledge. Applicant (Signature) (Title) (Date)

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