( )______________________________________________________

( )___________________________

( )___________________________( )___________________________

( )___________________________

( )___________________________

Company Name

Billing Address

Telephone

Fax Number

E-Mail

Social Security #

Federal Tax ID#

Years in Business:

Comp

Contact Name

any Name

Shipping Address

Telephone

Fa

Email

x Number

_________________________________

__________________________________________________________________

_________________________________

___________________ ___________________

___

If Di erent from Billing Address

Tax Exemption? _____ yes ___ no

Purchase Orders Required?

Type of Business?

a division of A/E Graphics Inc.

___ Proprietorship ___ LLC ___ Partnership ___ Ltd Partnership ___ Corporation

____ Yes____No

Acct Opened

Date Opened

______________________________________

Page 1 of 2

CREDIT APPLICATION

4075 North 124th StreetBrook�eld, WI 53005-1832(262) 781-7744Toll Free (877) 314-7047Fax (262) 781-4250billing@aegraphics.com

_________________________________

County

_________________________________Website

Incorporated in the State of: ___

_________________________________

___________________________________________________________________________________________________

__________________________________________________________________

_________________________________

( )___________________________

_________________________________

Supplier

Address

Telephone

Contact Name

1

__________________________________________________________________

_________________________________

_________________________________

Supplier

Address

Telephone

Contact Name

2

__________________________________________________________________

_________________________________

_________________________________

Supplier

Address

Telephone

Contact Name

3

GENERAL INFORMATION

SHIPPING INFORMATION

TRADE REFERENCES

Have you ever had an account with A/E Graphics, Inc. under any other name?

Not required for cash accounts

Street Address

_________________________________City, State, Ziprequired

IF YES, YOU MUST attach a completed and signed exemption certi�cate with this application.

_____________________________________________________Bank Name

_____________________________________________________Street Address

_____________________________________________________City, State, Zip

Contact

Phone Number

Name/Department

Telephone/Extension

BANK INFORMATION

_____________________________________________________

_____________________________________________________

PURCHASING CONTACT

_____________________________________________________

_____________________________________________________

Name/Department

Telephone/Extension

ACCOUNTS PAYABLE CONTACT

__________________________________________________________________________________________________________

E-mail Adddress _____________________________________________________

E-mail Adddress _____________________________________________________

D & B Number:

PLEASE LIST

OFFICERS, OWNERS, OR PARTNERS

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

A/E Graphics, Inc. 4075 North 124th Street, Suite A • Brookfield, WI 53005

(262) 781-7744

A/E Graphics, Inc.207 East Buffalo Street, Suite 32LL • Milwaukee, WI 53202

(414) 225-9870

Epic Color 4075 North 124th Street, Suite B • Brookfield, WI 53005

(262) 252-4577

CREDIT TERMS, CONDITIONS AND SECURITY AGREEMENTFor the purpose of establishing and maintaining credit, the statements and information provided in and with this application are full, true and correct. Applicant authorizes A/E Graphics, Inc. to make inquiry into, to request, and to receive any information concerning character, general reputation, �nancial or credit status from creditors or

�nancial institutions which A/E Graphics, Inc. deems relevant for the granting and collection of the proposed indebtedness and the Applicant authorizes any creditor or �nancial institution to divulge such information. Applicant understands that A/E Graphics, Inc. will rely on the accuracy of any information set forth in and with this application and all information obtained in determining whether to extend credit.

Applicant agrees to pay all charges within 30 days from invoice date. Applicant understands and agrees that payment for goods or services provided by A/E Graphics, Inc. in accordance with agreed-upon terms is not contingent on Applicants receipt of payment from any other party . A �nance charge of 1.5% per month (18% annual) will be added to all accounts that are not paid within our terms (Net 30 days), until the past due balance is paid. Minimum �nance charge will be $1.00. Applicant agrees to pay all costs of collection, including reasonable attorney fees, in the event Applicant fails to pay any charges when due. A/E Graphics, Inc. reserves the right to not extend credit to the Applicant or to withdraw credit at any time at A/E Graphics, Inc. sole discretion.

Applicant wishes to apply for credit with A/E Graphics, Inc. in accordance with these terms and conditions which have been read, understood and accepted. The undersigned is an o�cer or owner of Applicant and is authorized to represent and bind Applicant with respect to these matters.

SEC UR ITY AGREEMEN T. Applicant grants A/E Graphics, Inc. a security interest in goods A/E Graphics, Inc. sells to Applicant to secure payment for the goods and any other amounts Applicant owes A/E Graphics, Inc. now and in the future. Each invoice related to the goods supplements and is incorporated by reference into this Security Agreement. The security interest also covers all software related to the goods.

Signatur e Title Date

PERSONAL G UARANTEE: The undersigned jointly and severely promises to pay all charges made on the account opened with this information for the date below until such time as the guarantor shall withdraw his/her guarantee by a written document delivered by Certifed Mail to O�ce Manager, A/E Graphics, Inc. 4075 North 124th Street, Brook�eld, WI 53005 or ten (10) years from this date, whichever occurs frst. The maximum amount covered by this guaranty is $100,000.00.

Page 2 of 2

For more information about any of our se rvices,please call: (877) 314-7047

LOCATIONS

A/E GRAPHICS, INC. CREDIT APPLICATION

Name

O�ce Held

Address

City, State, Zip

_____________________________________________________

_____________________________________________________

_____________________________________________________

Guarantor’s Printed Name

Home Address

Date

_____________________________________________________

_____________________________________________________

_____________________________________________________

Signature

City/State/Zip

Tax I.D. or S.S.#

NameO�ce Held

Address

City, State, Zip

Name

O�ce Held

Address

City, State, Zip