EURO COLLECTIBLES  PO BOX 370565, Miami, FL 33137 - Tel (305) 672-1976/800.309.8336

Retailer Application Form

Please print, fill out completely and mail or fax to
(888) 302-3277

1. Company Profile

Name of Business   _________________________________________________________________________
Address
_________________________________________________________________________
City/State/Zip 
_________________________________________________________________________
Telephone                                             Fax
_______________________________      ______________________________

We are set-up as a: (____) Proprietorship  (____) Partnership   (____) Corporation

List Federal Tax ID Number: _____-__________    Sales Tax number:__________________________

*** Send Current Picture of Storefront ***

Name and Home Address of Proprietor/Partner(s) (Please print)

Name                                                                    Title
________________________________________________________________________
Address
________________________________________________________________________
City/State/Zip
________________________________________________________________________
Social Security No.
________________________________
Driver's License No.
________________________________

Name and Home Address of Proprietor/Partner(s) (Please print)

Name                                                                     Title
________________________________________________________________________
Address
________________________________________________________________________
City/State/Zip
________________________________________________________________________
Social Security No.
________________________________
Driver's License No.
________________________________

If Corporation, Officer's Names (Please print) 

Name of President
_________________________________________________________________________
Name of Buyer
_________________________________________________________________________
Person in Charge of Payables
_________________________________________________________________________

Date Business Established_____________      How Long At Present Location _______________

List Federal Tax ID Number: _____-__________

2. Bank References

Name of Bank                                             Contact 
_________________________________________________________________________
Address
_________________________________________________________________________
City/State/Zip 
_________________________________________________________________________
Telephone                                                       Fax
________________________                 ________________________
Type/Number of Account: 

Checking ____________________   Saving ________________________

3. Trade References

Name of Vendor 1                                                      Contact
_________________________________________________________________________
Address
_________________________________________________________________________
City/State/Zip
_________________________________________________________________________
Telephone                                            Fax
_________________________                 __________________________
Account No.                                          Credit Limit                       Terms
_________________________      ____________            ______________

Name of Vendor 2                                                      Contact
_________________________________________________________________________
Address
_________________________________________________________________________
City/State/Zip
_________________________________________________________________________
Telephone                                            Fax
_________________________                 __________________________
Account No.                                          Credit Limit                       Terms
_________________________      ____________            ______________

Name of Vendor 3                                                      Contact
_________________________________________________________________________
Address
_________________________________________________________________________
City/State/Zip
_________________________________________________________________________
Telephone                                            Fax
_________________________                 __________________________
Account No.                                          Credit Limit                       Terms
_________________________      ____________            ______________

This retailer/credit application and agreement is submitted by Customer to Euro Collectibles in order to obtain trade credit. Customer agrees to payment in full to Euro Collectibles for all amounts due according to Euro Collectibles invoice on or before net due date. Customer also agrees to pay interest on all amounts that are past due. Interest can be charged monthly at 1.5%. If Customer should default in any payment(s), Euro Collectibles has reserved the right to declare all invoice amounts due and payable without notice to Customer. Additionally, Customer will be responsible for all collection costs and attorney fees, whether suit is filed or not, in order to collect any delinquent amount. Customer also agree to provide Euro Collectibles with updated credit information on request and to provide an annual statement  to Euro Collectibles as a condition for the continue extension of credit. The undersigned certifies that all of the information contained herein is true and correct to the best of their information, knowledge and belief. Customer agrees to adhere to credit policies established by Euro Collectibles.

Authorized Signature: _____________________________________________________

Print Name______________________________________________________________

Title ________________________________  Date ______________________________

EuroForm RAF 2000

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