Adtech Credit Application

*Legal Name of Company	Trade Name (D/B/A)
*Federal ID/Company Registration Number
State Reseller ID/VAT Registration/GST Registration
*Website	*Adtech Location of Choice
*Industry	*Terms Requested
*Specify Other Industry	*Specify Other Terms

Billing Information

*Billing Mailing Address
*City	*State/Region/Province
*Zip/Postal Code	*Country
*Phone Number	*Fax Number
Time at Address	Years in Business
Type of Business	*Dun and Bradstreet Number
SIC Code	NAICS Code
*Person to Contact for Payment	*Contact Phone Number
*Contact Email Address	*Estimated Monthly Purchases

Primary Bank Information

Either attach your primary bank information here, or enter it below.

*Bank Name
*Street Address
*City	*State/Region/Province
*Zip/Postal Code	*Country
*Account Number	Additional Account Number

Trade Reference Information

Either attach your references here, or enter them individually below.

*Company Name
*Street Address
*City	*State/Region/Province
*Zip/Postal Code	*Country
*Account Numbers	*Contact
*Phone Number	*Fax Number

*Company Name
*Street Address
*City	*State/Region/Province
*Zip/Postal Code	*Country
*Account Numbers	*Contact
*Phone Number	*Fax Number

*Company Name
*Street Address
*City	*State/Region/Province
*Zip/Postal Code	*Country
*Account Numbers	*Contact
*Phone Number	*Fax Number

Resale Certificate / Uniform Use & Sales Tax Certificate

Check here if you are a Reseller.

*Please attach Resale Certificate or Uniform Use & Sales Tax Certificate.

*All respondents are required to attached their W-9.

Our Credit Policy

This credit application and agreement is submitted by the undersigned authorized representative (hereafter Customer). Customer agrees to make payment in full to Adtech for all amounts due according to Adtech invoice(s), Customer also agrees to pay Adtech as interest, an amount equal to 1.5% per month, or the maximum provided by law (whichever is less) for invoice amounts that are past due. Should Customer default in any such payment(s), Adtech shall have the right, without notice to Customer, to declare all invoice amounts immediately due and payable. In the event Adtech should commence any action or actions, or otherwise seek to enforce this agreement against Customer or any Guarantor, Customer agrees to pay reasonable attorney(s) fees, court and other expenses incurred by Adtech, whether or not suit is filed, This agreement is not transferable or assignable without prior written consent of Adtech. This agreement shall become effective upon acceptance by Adtech . Customer agrees that all sales shall be governed by Adtech's Standard Terms and Conditions of Sale, as stated on the invoice and/or shown in Adtech WEBSITE, unless Adtech and Customer have executed a separate agreement which specifically replaces those terms and conditions.

Customer and Customer's authorized representative signing this agreement hereby represent and warrant that the information provided in this application and in any and all additional documents, financial statements or other information furnished by Customer to Adtech is true and correct in all material respects and contains all information necessary so that this application is not materially misleading. Customer acknowledges that Adtech is relying on the accuracy of the information provided by Customer. Customer hereby grants Adtech a security interest in any and all goods purchases by Customer from Adtech to secure any and all obligations of Customer to Adtech, including but not limited to any obligation of payment. Customer agrees to execute any additional documents necessary to perfect or continue any security interest related to this application. Customer agrees to adhere to the credit service policies and procedures established from time to time by Adtech.

The undersigned individual(s) who is (are) either a principal (s) or partner(s) or officer(s) of the above-named Customer or a sole proprietorship of the above-named Customer, recognizing that his or her individual credit history may be a factor In the evaluation of the credit history of Customer, hereby consents to and authorizes the use of a consumer credit report on the undersigned, by Adtech, the named business credit grantor, from time to time as may be needed, in the credit evaluation process.

*Check here if you have read and accept these terms of our credit policy.