Business Contact Information

Company Name:

Tax ID:

Contact Name:

Contact Title:

Phone:

Fax: (optional)

Email:

Registered Company Address:

City:

State:

ZIP Code:

Date Business Commenced:

Business Type: Sole proprietorship:Partnership:Corporation:Other:

Business And Credit Information

Bank Name:

Bank Address:

City:

State:

ZIP Code:

Phone:

Type of Account

Savings

Savings Account Number: (if Savings Account)

Checking

Checking Account Number: (if Checking Account)

Other

Other Account Number: (if Other Account)

Business/Trade References

Reference #1

Company Name:

Company Address:

City:

State:

ZIP Code:

Phone:

Fax: (optional)

Email:

Type of Account: (if applicable)

Reference #2

Company Name:

Company Address:

City:

State:

ZIP Code:

Phone:

Fax: (optional)

Email:

Type of Account: (if applicable)

Reference #3

Company Name:

Company Address:

City:

State:

ZIP Code:

Phone:

Fax: (optional)

Email:

Type of Account: (if applicable)

Agreement

1. All invoices are to be paid 30 days from the date of the invoice subject to credit approval by Lyon Capital.

2. Claims arising from invoices must be made within seven working days.

3. By submitting this application, you authorize Matrix Imports, Inc. to make inquiries into the banking/trade references that you have supplied.

Electronic Signatures

Signature:

Date:

Co-Signature: (if applicable)

Date: