CREDIT APPLICATION Terms of payment will be C.O.D. until applicant has been notified by Scavuzzo’s Credit Dept. that credit has been approved. SHIP TO BILL TO Accounts Payable Contact Firm Name Prefered Contact Method Address Trade Name City, State, Zip Address Phone No.Fax No. City, State, Zip Email Address Phone No. OWNERSHIP INFORMATION Corporation Partnership Sole Proprietor Healthcare Group Purchasing (If Incorporated): Name School Date In Business Since: State Has Business Filed Bankruptcy? Yes No PURCHASES, STATEMENTS, TERMS, METHOD PAYMENT: Estimated Weekly Purchase: $Payment Method: ACH CHECK CREDIT CARD CASH PLEASE LIST ALL OWNERS, PARTNERS, CORPORATION OFFICERS NameDate of Birth NameDate of Birth Title Title Home Address Home Address Phone No. Phone No. Social Security No. Social Security No. NameDate of Birth NameDate of Birth Title Title Home Address Home Address Phone No. Social Security No. Phone No. Social Security No. BANKING INFORMATION Bank Name Officer Phone No. Address Checking Account No. Balance City, State, Zip Loans Balance BANKING INFORMATION Tax Exemption Status: Resale Only YES NO Resale Tax ID Number All Sales YES NO Tax Exempt ID Number In consideration of the granting and extension of credit by Scavuzzo’s Inc to the undersigned, it is hereby agreed that the undersigned will promptly pay all sum when due. In the event of non-payment, the undersigned does hereby agree to pay in addition to the principle amounts due, all collection and/or attorney’s fees and all court costs. Signature Printed Name Title SALES AFICIONADO WE LOVE WHAT WE DO. SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120 Date CREDIT CARD AUTHORIZATION SHIP TO ADDRESS Business Name Street City, State, Zip Phone No. Fax No. I, Hereby authorize Scavuzzo’s Inc. to charge my credit/debit card ac- count for services rendered/products sold to all people using my customer account number/numbers even though the card is not present at the time of transaction/delivery. This continuing authorization is valid until such time as I inform Scavuzzo’s Inc in writing to the contrary. Cardholder’s SignatureDate CREDIT CARD INFORMATION Visa Mastercard American Express BILLING ADDRESS Discover Name on Card Street Credit Card Number City, State, Zip Expiration Date Phone No. Name of Issuing Bank Fax No. Upon Delivery of order, the credit/debit card account above will be charged for the full amount of the purchase. If product is to be picked-up at Scavuzzo’s Inc and not picked up within 2-3 days of pick-up request, then a restocking fee will be charged. SALES AFICIONADO WE LOVE WHAT WE DO. SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120 ACH / DEBIT AUTHORIZATION I, Hereby authorize Scavuzzo’s Inc. to initiate debit entries to the account indicated below. ACCOUNT INFORMATION DDA SAV Receiving Bank’s Routing No. [ABA] Account No. Name This authority is to remain in full force and effect until Scavuzzo’s Inc has received written notification from me of it’s termination in such time and such manner as to afford Scavuzzo’s Inc a reasonable opportunity to act on it. Printed Name Signature Date SALES AFICIONADO WE LOVE WHAT WE DO. SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120 PERSONAL GUARANTY For value received and to induce you to extend credit hereunder, the undersigned jointly and severally guarantee payment of any and all indebtedness, which (Hereinafter “Company”) has in- curred or may incur in the performance of all obligations of said company to Scavuzzo’s Inc. That liability of the undersigned shall not be affected by the amount of credit extended hereunder, by an change in the form of indebtedness, by note or otherwise, or by renewal or extension thereof. Notice of acceptance of this guaranty, of the extension of said indebtedness, of orders, of deliveries, of default in payment, of the release of the whole or part of the indebtedness, or of any other matter with respect hereto, is waived. This guaranty shall be enforceable before or after any proceeding against the company and shall be effective regardless of the solvency of the company, the subsequent incorporation or failure of incorporation, the assignment, transfer or sale of said company or by any other change in the composition, nature, personnel or location of the company. Should this matter be referred to an attorney for collection, the undersigned shall pay all expenses of collection and attorney’s fees incurred by reason of the default of the company. The undersigned personal guarantor, recognizing that his or her individual credit history may be a necessary factor in the evaluation of this personal guaranty, hereby consents to and authorizes the use of a consumer credit report on the undersigned, by the above named business credit grantor, from time to time as maybe needed, in the credit evaluation process. Execution Date Of NameDate of Birth NameDate of Birth Home Street Address Home Street Address City, State, Zip City, State, Zip Social Security No. Social Security No. Signature Signature A copy of your identification will be necessary to confirm the above printed information. SALES AFICIONADO WE LOVE WHAT WE DO. SCAVUZZOS.COM I (816) 231-1517 I 2840 GUINOTTE AVE, KANSAS CITY, MO 64120