Print Out Form Below, Complete and Fax for Credit Application

COMPLETE ALL APPLICABLE SPACES

Date:________________________________

Full Legal Name:_________________________________________________________________

Street Address:__________________________________________________________________

City, State:_____________________________________________________________________

Ship To Address:__________________________ Phone:____________________________

(If Different) __________________________ Fax: ____________________________

Credit Card # ___________________________________________________________________

If paying by Check _____ (please mark this box if paying by check)

FEDERAL ID No:_________________________________

Check One: Corporation______ Partnership______ Proprietorship______

State of Incorporation:______ Year Incorporated (Began Business):__________

President:_________________________ V. President:_________________________

Home Office Address:____________________________________________________

(If Division or Branch):____________________________________________________

Telephone:_____________________________

Taxable:______ Non-Taxable______ Tax Exemption Number:_____________________

(Attach Completed Exemption Certificate)

Are Purchase Orders Required:__________ Will Backorders Be Accepted:__________

Person To Contact Regarding Orders:_______________________________________

Accounts Payable:______________________________________________________

Accounts Payable Telephone:______________________________________________

BANK REFERENCE

Bank:____________________________ Officer:_____________________________

Address:_____________________________________________________________

Account Number:______________________________________________________

Telephone:_________________________________

TRADE REFERENCES

1. Company:___________________________ Address:___________________________

Account Number:________________________ Fax:______________________________

Phone:______________________________

2. Company:___________________________ Address:___________________________

Account Number:________________________ Fax:______________________________

Phone:______________________________

3. Company:___________________________ Address:___________________________

Account Number:________________________ Fax:______________________________

Phone:______________________________

Company Name:___________________________________________

Authorized Signature:______________________________

Title:____________________

Web Address if available: ____________________________________

E-Mail Address if available: ___________________________________

Print Name Please:__________________________________________

Aprons | Specialty | Hats/Misc. | Order | Credit Application | Gamco, Inc.

Customer Service 1-800-362-7766 extension #11