CREDIT APPLICATION Indera Mills Company P.O. Box 309, Yadkinville, N.C. 27055   (336) 679-4440   Fax (336) 679-4475

Business Name /DBA		Main Email
Corporate Name		Telephone
Bill To Address		Ship To Address (If needed attach additional  addresses at bottom of page.)
Account Payable Telephone Number		Accounts Receivable Telephone Number
Accounts Payable Fax		Accounts Payable Email
Accounts Payable Contact		Is Purchase Order Required	YesNo

Corporation               Partnership               Sole Proprietorship

Number of Years in Business

Federal Tax ID Number (for Corporations)

Owners, Partners or Corporate Officers

Name/Title	Home Address	Telephone Number	Social Security Number
Bank Name		Officer
Bank Address		Account Number
		Telephone Number

Trade References (minimum of 4 required - attach additional at bottom of this page if needed)

Account Name		Account Number		Telephone Number
Address			Fax Number
Account Name		Account Number		Telephone Number
Address			Fax Number

Account Name		Account Number		Telephone Number
Address			Fax Number
Account Name		Account Number		Telephone Number
Address			Fax Number
Account Name		Account Number		Telephone Number
Address			Fax Number

If you wish, orders may be shipped C.O.D or via Credit Card, to your authorized locations until verification of credit has been completed.  No shipment can be made, however, until this authorized dealer application has been signed and returned to our Credit Department.

Annual Sales
Primary Product Lines	BicycleOutdoorSkiing/SnowboardingGeneral SportingOther

Credit Limit you are Requesting		Opening Order Amount (minimum $500)
Financial Statements Attached  (Upload at bottom of page)	YesNo	Will be forwarded on (date)

We hereby apply for the extension of credit by your company.  The following is submitted as a basis for your consideration.  All information is warranted to be true and accurate.

Business Name /DBA
Corporate Name		Telephone
Bill to Address		Ship to Address

Terms:    All orders are subject to credit approval.  Once the Dealer's credit has been approved, payment terms will be  Net 30 Days from Date of Invoice or as agreed.

SHIPMENTS Shipments are F.O.B Yadkinville, N.C.; shipping charges will be listed separately on invoices.  Payment terms will be Net 30 days from date of FINANCE. REFUSED SHIPMENTS Shipments are the sole responsibility of the customer.  Liability rests with the Dealer if the shipment is refused.  Freight plus a 20% repackaging / restocking charge will be assessed on refused shipments.  This includes refused back orders.  It is the Dealer's responsibility to cancel back orders. RETURNS Authorizations may be requested for the return of items shipped in error.  Contact Customer Service for a Return Authorization Number.  Items returned without authorization or which do not appear on our current price sheet will not have credit value.  If an authorization is issued for reasons other than a Indera Mills' error, a 20% repackaging/restocking fee will be assessed.  Refused C.O.D orders are subject to a 25% repacking / restocking fee.  Freight will be paid by the Dealer. ALL RETURNS UNLESS OTHERWISE STATED ARE TO BE RETURNED TO: Indera Mills Company, 350 West Maple Street, Yadkinville, N.C. 27055 MISCELLANEOUS No claim/chargeback, action, or demand may be brought by the Dealer more than one year after date of invoice.  The Dealer will pay all costs, including reasonable attorney fees and costs and court costs, incurred in any collection proceeding that was initiated as a result of the Dealers default.

I hereby authorize the person or firm to whom this application is made, any credit bureau, or other investigative agency employed by such a or entity, to investigate the references herein listed or statements or other data obtained from me or from any other person pertaining to my person credit and financial responsibility.

Company Name	Indera Mills Company	Dealer Company
By (Signature Required)		By (Signature Required)
Name		Name
Title		Title
Address		Address

You can upload additional shipping addresses, trade references, and financial statements here if needed. Please be sure that any files that you plan to upload include your company name and description of what the file inludes. Example: inderamillsfinancialstatements.doc coldprufshiptoaddresses.txt