Credit Application -

Credit Application Form

Business Information

Trade Name

Former Name

Address Line 1

Address Line 2

City

State

Zip Code

CT Tax ID #

Sales and Use Permit Number

Phone

Fax

Backer Information

First Name

Last Name

Date of Birth

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone Number:

Permittee Information

First Name

Last Name

Permit Number

Permit Expiration Date

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone Number:

Credit References

Reference 1:

Name

Phone

Reference 2:

Name

Phone

Reference 3:

Name

Phone

Bank Reference

Bank Name

Type of Account

Bank Name

Type of Account

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Backer’s Statement

Your Name

Residing At:

for and in consideration of F&F Distributors, Inc extending at my request credit to:

Company Name:

dba

(hereinafter referred to as the “Company”), personally guarantees to you the payment at New London, CT of any obligation of the Company and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Company whenever the Company shall fail to pay the same. It is understood that this guaranty shall be continuing and irrevocable guaranty and indemnity for such indebtness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed. I agree that should it become necessary to place my account in collection I will pay all costs incurred by F&F Distributors, Inc plus reasonable Attorney’s fees and/or collection fees.

Signature

Backer’s Signature

Backer’s Email Address

Date