Address:_____________________________ City:__________________ State/Prov:______ Zip/Postal:_________

Buyer’s Name_________________________ A/P Name:______________ Type of Business:_____________________

Ship To Location: (if different than above)

Address:_____________________________ City:__________________ State/Prov:______ Zip/Postal:_________

Telephone No. _______________________ Fax No.________________ E-mail:_______________________________

Amount of Credit Requested:__________ Fed I.D. No. USA______________________________________________

State/Prov Resale Tax No.____________ GST No. Canada________________________________________________

Bank:________________________________ Contact:__________________________ A/C #:_____________________

Address:_____________________________ City:__________________ State/Prov:______ Zip/Postal:_________

Company: ___________________________________ Contact:___________________________ A/C #______________

Address:____________________________________________________________________________________________

City:________________ State/Prov:______ Zip/Postal: _________ Tel. No.__________ Fax No.____________

Company: ___________________________________ Contact:___________________________ A/C #______________

Address:____________________________________________________________________________________________

City:________________ State/Prov:______ Zip/Postal: _________ Tel. No.__________ Fax No.____________

Company: ___________________________________ Contact:___________________________ A/C #______________

Address:____________________________________________________________________________________________

City:________________ State/Prov:______ Zip/Postal: _________ Tel. No.__________ Fax No.____________

Name_____________________________________________________ Position _________________________________

Signature _______________________________________________ Date: ____________________________________

Signature _______________________________________________ Date: ____________________________________

Please Print ____________________________________________ Title: ___________________________________

Terms of Sale, including price, terms of payment and charges, for each purchase are agreed to be those specified on the face of each invoice.

The Customer hereby agrees to pay all costs of collection or legal fees should such action be necessary due to non-payment.

Any legal suits may be commenced in the State of New York (US customers), and Toronto, ON (Canadian customers), and the undersigned waives any right to a trial by jury.

The above information is willingly supplied and AtenPac Corporation is authorized to contact the above bank and trade references in order to establish the creditworthiness of the above named company.

If applicant is not a corporation or under new management, AtenPac Corporation is authorized to obtain credit reports about proprietors, partners or principals.

Should credit availability be granted by AtenPac Corporation, all decisions with respect to extension or continuation shall be in the sole discretion of AtenPac Corporation. AtenPac Corporation may terminate any credit availability within its sole discretion.

Disputes to any charges must be registered in writing within 5 business days from receipt of any invoice.

I have read the above conditions and hereby agree to them.

Legal Business Name:__________________________________ Officer Signature:___________________________

DBA Name: ____________________________________________ Officer Name (print):________________________

Date:_________________________________________________ Title:_______________________________________

The vendor must collect the tax on a sale of taxable property or services unless the purchaser gives him/her/the company a properly completed resale certificate or exemption certificate.

The undersigned hereby certifies that he/she/the company:

• Holds a valid Certificate of Authority to collect state/provincial and local sales and use tax, as applicable.

• Is principally engaged in (indicate nature of business):___________________________________________

• Intends that the tangible personal property is for resale in its present form or as a component part of tangible personal property; or the tangible personal property is for use in performing taxable services where such property becomes a component part of the tangible personal property upon which the services are performed or will be actually transferred to the purchaser of the service in conjunction with the performance of the service.

• Understands that this certificate may not be used to purchase items or services which are not for resale and that he/she/the company will pay the use tax on tangible personal property or services purchased pursuant to this certificate and subsequently used or consumed in taxable manner, and that any erroneous or false use of this certificate will subject him/her/the company to payment of tax plus penalties and interest.

Officer Signature:______________________ Name of Company:___________________________________________

Title:__________________________________ Street Address:____________________________________________