CREDIT APPLICATION

Personal Guaranty

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Owner(s) Information

Name of Owner (1)*

First Last

Address of Owner (1)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Owner (2)*

First Last

Address of Owner (2)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Trade Reference 1

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Trade Reference 2

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Trade Reference 3

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Banking Information

Bank Name

Phone

Account Number

Contact Name

Agreement

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. THIS INFORMATION WILL BE USED ONLY FOR OPENING AN ACCOUNT WITH COSTA VERDE IMPORTS, INC. IF CREDIT IS APPROVED, APPLICANT AGREES TO BE RESPONSIBLE FOR ALL PURCHASES FROM FB IMPORTS, LLC D/B/A COSTA VERDE IMPORTS., AND AGREES TO PAY IN ACCORDANCE WITH THE TERMS OF CREDIT. APPLICANT AGREES TO PAY ALL LEGAL FEES AND FINANCE CHARGES ASSOCIATED WITH COLLECTION OF APPLICANT’S ACCOUNT. ANY LEGAL ACTION OR COLLECTION PROCESS SHALL BE GOVERNED UNDER THE LAWS OF FLORIDA.

Signature

Title

Date

CREDIT APPLICATION

Personal Guaranty

Company Information

Owner(s) Information

Trade Reference 1

Trade Reference 2

Trade Reference 3

Banking Information

Agreement

Products

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