OUR TERMS OF SALE: Net 30 days. A finance charge of 1.5% per month is subject to all charges past 30 days. This is an Annual Percentage Rate of 18%.

CREDIT AGREEMENT: After 90 days and if the matter is placed with an attorney or collection agency for collection, whether or not suit is brought hereon to enforce payment, we agree to pay all costs of collection including a reasonable attorney's fee.

In consideration of your extending credit, the undersigned assumes full responsibility for bills incurred as a result of this application.

I hereby authorize the above named firms and banking institutions to furnish information requested by ALK Abello, Inc. to process this application and I agree that the said persons shall not be liable for any claim or damages as a result of furnishing the requests.

I certify that all of the information on this form is correct. I fully understand your credit terms and agree for the proper payment in consideration of extended credit.

I understand that ALK-Abello, Inc. will update account information on our practice annually and we will be required to fill out the customer account information form when requested.

*If you are tax exempt, we must have a copy of your exemption certificate for our files.

If you have any questions regarding this application, please contact the Accounts Receivable Department at 866-255-7722 ext. 460. Your completed credit application will be reviewed promptly and our staff will contact you within 48 hours