KV COLLECTIONS, INC. 6832 East Slauson Ave. Commerce, CA 90040 Phone: (323) 888-1036 Fax: (323) 888-9525 www.kavio.com

Trade References Form

* This form must be completed in full and signed if applying for credit terms. please print-out this form and FAX to us at (323) 888-9525.

This is my authorization to release information to KV Collections, Inc. for the purpose of supporting the credit application and establishing an open credit line.

Account Name:
Address:
City:				State:			Zip:
Telephone:
Fax:
Contact Person:

TRADE REFERENCES

Name:     Name:   Name: Address:     Address:   Address: City:     City:   City: State:     State:   State: Zip:     Zip:   Zip: Tel:     Tel:   Tel: Fax:     Fax:   Fax:

BANK REFERENCES

Bank:     Bank:   Address:     Address:   City:     City:   State:   Zip:   State:   Zip: Tel:     Tel:   Fax:     Fax:   AccountNumber:     AccuntNumber:   ContactPerson :     ContactPerson:   The entire balance of all credit accounts are due and payable according to the terms of the sale of each invoice. In the event that the delinquent account is placed with a licensed collector, or attorney for collection, or suit is instituted on the account, in addition to the amount of the account, the undersigned acknowledges that all orders are subject to approval by KV COLLECTIONS INC. The undersigned agrees that each purchase hereafter completed upon open account credit shall be deemed subject to the terms herein agreed upon.   _________________________________ Customers's Signature     __________________________ Date   Click here for print document acrobat reader version