Please take a moment to tell us how you heard about our company.

1. Business Name

2. Address

3a. City, State, Zip

3b. Shipping Preference (domestic only) International requires special quoting.
FedEx>>Ground $5.75 FedEx>>2nd Day $8.00 FedEx>>Overnight $11.00 Professional Delivery>>$3.00 USPS>>$1.20

4a. Telephone Number

4b. Email Address

4c. Fax Number

5. D/B/A

6. Federal Tax ID Number

7. Type of Business

8. Ownership: Sole Owner Partnership Corporation

9 .   Principal. Name:
        Title:
        SS #:
        Home Address:

10.   Principal. Name:
        Title:
        SS #:
        Home Address:

11. Profession
State License #:

12. Date Established

13. Number of Employees:

14. Trade References (name of suppliers of major products and services).
      Name, Account Number City, State, Phone Number
a.
b.
c.

15. Bank Reference: Checking, Loan, or Savings
      Name, Account Number City, State, Contact Person
a.
b.
c.

16. Estimated Annual Sales:

17. Has the company or any of its Principals ever filed for bankruptcy? Yes No
If yes, please explain:


18.   Mortgage Holder/Landlord:
        Address:
        Phone Number:

19. Applicant agrees to pay any collection costs incurred to collect the amount balance, including
reasonable attorney’s fees. The undersigned will/will not submit a financial statement. The under
signed as an inducement to grant credit warrants that the information submitted is true and correct.
You are authorized to investigate the credit references listed above.

(Name)
(Title)

(Name)
(Title)

(Name)
(Title)

(Name)
(Title)

20. Personal Guarantee.
In consideration of credit being extended by ABBA Optical, Inc. to the above named applicant for
merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to ABBA Optical, Inc. the faithful payment, when due, of all accounts of said applicant for purchases made within five years next after the date of this application. The undersigned guarantor of guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by ABBA Optical, Inc. extension of time of payment to applicant, acceptance or partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to: ABBA Optical, Inc. 2230 Centre Park Court, Stone Mountain, GA 30087.

(Name)
(Social Secutiry #)

Please enter the number you see below

704957