Airwave

Account Credit Application

BILLING ADDRESS

LOCATION: FIRST NAME: LAST NAME: BUSINESS NAME: STREET: CITY: STATE: ZIP: EMAIL ADDRESS:

PHYSICAL ADDRESS

STREET: CITY: STATE: ZIP:

PHONE: FAX: ZIP:

RESPONSIBLE PARTY

DOB: DRIVER’S LICENSE NUMBER: ADDRESS: STREET: CITY: STATE: ZIP: SOCIAL SECURITY/AND OR FEDERAL TAX ID NUMBER:

CREDIT REFERENCES

REFERENCE #1

CONTACT PERSON: PHONE NUMBER:

REFERENCE #2

CONTACT PERSON: PHONE NUMBER:

BANK NAME: BRANCH: PHONE NUMBER:

PERSONAL REFERENCE

NAME: ADDRESS: PHONE NUMBER:

AGREEMENT TO PAY COLLECTION COSTS:

In the event that it is necessary for Airwave Communications Ent. to retain attorneys for the collection of any sums owed from the undersigned or any personal grantor, the undersigned agrees to pay all costs of collection, including attorneys fees incurred in the process.

AGREEMENT TO PAY INTEREST:

The undesigned applicant agrees to pay interest on any credit extended to applicant. A Finance Charge will be imposed if the total amount due is not paid within the 30 days from the date of purchase.

I DELCARE THAT THE FORGOING INFORMATION IS TRUE AND CORRECT. I AUTHORIZE THE VERIFICATION AND OBTAINING OF A CONSUMER CREDIT REPORT IN ORDER TO PROCESS APPLICATION.

Airwave communications reaching new heigths in professional communication resourses plus services