Business Establishment Year: D&B Number: How did you hear about Foxx Equipment Co.? CREDIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL AND SIGNED BEFORE CREDIT CAN BE PROCESSED 421 Southwest Blvd, Kansas City, MO 64108 TF: 1 (800) 821-2254 Local: (816) 421-3600 Fax: (816) 421-5671 955 Decatur St, Unit A, Denver, CO 80204 TF: 1 (800) 525-2484 Local: (303) 573-1766 Fax: (303) 893-3028 Company Name: Business Phone Number: Street Address: City, State, Zip: Account Payable/Name: Purchasing Department/Name: Tax Exempt: IF YES, PLEASE PROVIDE A COPY OF EXEMPTION CERTIFICATE(S). Type of Ownership: Type of Business (check one or more as applicable): Trade Reference: Address: City, State, Zip: Phone: Bank Reference: Address: City, State, Zip: Phone: Fax: Account No.(s) Savings: Checking: Fax Number: Yes Corporation Partnership Individual No Email: Email: Date: Bottler/Beverage Distributor Brew Pub/Brewery Bar/Restaurant Beer/Liquor Wholesaler Vending/Office/Coffee/Catering Beer Distributor (brands): Home Brew/Home Wine Shop Fast Food/Chain Restaurant/C-Store Institution (hospital, school, hotel, casino) Refrigeration/Ice Machines Sales & Service Food Service Distributor Liquor Retailer Individual Welding/Carbonic Gas Other: APPLICATION IS HEREBY MADE AND THE FOLLOWING REFERENCES ARE GIVEN. IT IS UNDERSTOOD THAT THE INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE AND USED ONLY BY FOXX’S CREDIT DEPARTMENT www.foxxequipment.com @foxxequipmentcompany @foxxequipment /foxx-equipment-company List names of principal company officers or owners: Name: Title: Name: Title: PLEASE NOTE: FOXX EQUIPMENT COMPANY terms are NET 30 DAYS . A finance charge of 1.5% per month (which is an annual percentage of 18%) is charged on all past due accounts. The purchaser will be responsible for all collection costs if invoices are not paid pursuant to the terms and conditions of this application. By signing, you authorize each reference listed above to release information to FOXX EQUIPMENT COMPANY by telephone, fax, mail or email; and that you understand Foxx Equipment Company’s terms and agree to abide by them. X: Date: Authorized Signature ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐