Credit Application

Company Name*

Phone*

Email*

Fax*

SSN

FEI#

Address*

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

Structure*

Corporation
Partnership
Individual
Other

Years In Business*

D&B

SIC Code

Tax Exempt*

Please attach tax-exempt certificate

PO Required*

Maquiladora ID

Please attach a copy of your Maquila Certificate

NAMES OF PRINCIPLES

Name*

First Last

Title*

Name

First Last

Title

Name

First Last

Title

TRADE / SECURED REFERENCE

Name*

Address*

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

Contact*

Phone*

Fax

Name

Address

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

Contact

Phone

Fax

Name

Address

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

Contact

Phone

Fax

Name

Address

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

Contact

Phone

Fax

BANK REFERENCES

Name*

Address*

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

Contact*

Phone*

Fax

Name

Address

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

Contact

Phone

Fax

ADDITIONAL INFORMATION

Accounts Payable Contact

Name*

First Last

Phone*

Fax*

Email*

Additional Contact

Name

First Last

Phone

Fax

Email

LOCATION INFORMATION

Equipment Location

Ship To Address

Equipment Location

Ship To Address

IF SERVICE IS BEING REQUESTED FOR MEXICO, A MAQUILA CERTIFICATE MUST BE SUPPLIED PRIOR TO SERVICE.

TERMS AND CONDITIONS

We agree to pay all invoices issued by Medley Material Handling Company according to terms. If any invoices should fall past due, we understand that there will be late fees and services charges applied that we will be responsible for. A $ 25.00 fee is charged on all return checks. Any service or billing issues should be sent to Medley Material Handling Company in writing with in 30 days of the original invoice date. We understand that all property and material belonging to Medley Material Handling Company remains We authorize the vendors to release the necessary credit information to Medley Material Handling Company. I agree to the above terms:

Digital Signature*

Title*

Printed Name*

Date*

PERSONAL GUARANTEE

In consideration of any extension of credit, loan, or other financial accommodation heretofore, now or hereafter made to

*

(“Account Debtor”) by Medley Material Handling Company, the undersigned hereby guarantees absolutely and unconditionally the prompt payment when due, and at any time thereafter, of all indebtedness and obligations of every kind and nature of Account Debtor to Medley, absolute or contingent, due or to become due, now or hereafter existing (the “Indebtedness”), and in addition, the undersigned agrees to pay all expenses, including attorneys fees and legal expenses, paid or incurred by Medley to collect the Indebtedness, or any part thereof, and to enforce the guaranty. The liability of the undersigned under the guaranty shall in no way be affected by any compromise, waiver, settlement, change, subordination, modification or disposition of the Indebtedness, and in order to hold the undersigned liable hereunder, there shall be no obligation on the part of Medley at any time to resort first for payment to the Account Debtor, or any other guarantor, and Medley shall have the right to enforce this guaranty irrespective of whether or not proceedings or steps are being taken against any party primarily or secondarily liable on the Indebtedness. The undersigned waives presentment, protest and notice of dishonor or default, notice of acceptance of the guaranty, notice of extensions of, credit or other actions taken in reliance hereon, and all demands and notices of any kind in connection with this guaranty of the Indebtedness. Medley, without notice of any kind, may sell, assign, or transfer any of the Indebtedness to a third party, and in such event, each successive assignee, transferee or holder or any of the Indebtedness shall have the right to enforce this guaranty for the benefit of such assignee, transferee or holder. This guaranty shall be binding on the heirs, legal representatives, successors, and assigns of the undersigned and shall insure to the benefit of Medley, its successors and assigns.

Date*

GUARANTOR SIGNATURE*

GUARANTOR PRINTED NAME*

866.734.6687

Please complete the Credit Application.

NAMES OF PRINCIPLES

TRADE / SECURED REFERENCE

BANK REFERENCES

ADDITIONAL INFORMATION

Accounts Payable Contact

Additional Contact

LOCATION INFORMATION

IF SERVICE IS BEING REQUESTED FOR MEXICO, A MAQUILA CERTIFICATE MUST BE SUPPLIED PRIOR TO SERVICE.

TERMS AND CONDITIONS

PERSONAL GUARANTEE

In consideration of any extension of credit, loan, or other financial accommodation heretofore, now or hereafter made to