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carryoutmenu inc.

Commercial Account Applica tion

Applying for (check one): House Account (omit section D)

Print Form

Credit Card Authorization Account (omit section B)

Section A: Company Information

Business Name: Phone#:

Address:

Fax#:

City:

State:

Zip:

Suite#:

Section B: Financial & Bank Information

Business Legal Name: Type of Entity (Corp, LLC, Partnership?: Years in Business:

Federal Tax ID #:

Accounts Payable Contact Name:

Phone #:

Bank/Branch:

Bank Phone#:

Acct#:

Section C: Authorized Users

The following individuals are authorized to charge deliveries on the House Account/Credit Card Account Name Phone# Ext.

If additional space is needed, please list on an attached sheet of company letterhead

carryoutmenu inc.

Commercial Account Applica tion

Section D: Credit Card Information

The following credit card will be the primary payment method (for "no-show" credit card accounts) or secondary payment method (for House Accounts). For house accounts, all unpaid amounts over 30 days shall be considered delinquent and will be charged to the credit card on file along with a $25 late fee, and credithold or cancellation

Cardholder Name Credit Card # Credit Card Billing Address Cardholder Signature Cardholder Phone# Expiration Date Billing Zip CVV2 Code Date

Please print & sign document before emailing or faxing document in

Attach a photocopy of the credit card below

Terms and Conditions: all applicants must read & sign:

e undersigned hereby agrees to pay all bills when due, to pay a nance charge of 5% per month on any balance on any sums not paid when due. e undersigned also authorizes Carryout Menu Inc. to conduct a credit check & to verify the information & bank references provided in the application for the account. e undersigned, by this application and agreement, does personally guarantee payments for all goods delivered and services provided by CarryoutMenu.com (Carryout Menu Inc.). e undersigned personally assumes joint and several responsibilities with the applicant company. In the event that payment is not made, the undersigned agrees to pay all reasonable attorneys' fees & court or other collection costs as permitted by law. You may cancel the commercial account upon 15 days written notice to Carryout Menu Inc. You agree to be responsible for any outstanding balance & any new charges by authorized users incurred up to & including up to & including the date of cancellation

Authorized Signature

Title

Date

Please Email or Fax Application to: Fax: 443-276-0908 (after faxing, please call to ensure we have received your faxed application) Email: [email protected] 410-772-1072 (Call if you have any Questions) RESET FORM Order Online at www.CarryoutMenu.com

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