EFTA00525149.pdf

STARK CARPET FABRIC WALLCOVERING FURNITURE CONFIDENTIAL ACCOUNT APPLICATION ALL NEW ACCOUNTS ARE PROFORMA ACCOUNTS 979 Third Avenue New York, NY 10022 Credit Department Tent 212-752-9000 En. 7136. Fax* 718-784-0731 COMPANY INFORMATION Company Name JSC,T,44,„io/zs LI-C._ Contact 4,2 ?k,b,4ed /44../ Years in Business Lit Billing Address 575 Letr,:lioN e9-ve, 967cian.. City IVY State AJ r Zip 1000,1•Q Phone] Fax Email Bank Reference Avisaas 64.4(.-Account ft Bank Contact S ilevidizef op;e1g Phone Tyne of Business: "(Interior Designer • f Architect • I.• Specifier • fl Purchasing Agent • L: Hospitality • P Contract • Other Dun & Bradstreet,/ OWNER INFORMATION (Must be completed for all partnerships and sole proprietorships) Check One: IT Corporation • OCLIC • U Partnership • U Sole Proprietorship • Owners Full Name Cilome Sipcfram SS# Federal ID # Owners Address / 4,40/ va 515" ig,14/,-;v0 14 City AV/ State /4 V Zip /00.2,) Partners Full Name ( If Partnership ) SS# Partners Address City State Zip TRADE REFERENCES I. Name hYlan/the;fq Phone Account(' Address City State Zip 2. Name At+ Phone goo- bLfclot fi Account# Address City State Zip 3. Name Phone Account(' Address City State Zip I authorize Stark Carpet Corp. o con t any of my references as well as my banking, business and consumer reporting agencies in order to establish credit terns. I agree to pay interest at a rate of I Si% per mon ( % per annum) for all np id past due invoices. I also agree to pay reasonable costs of collection, including attorney's fees, in the event of my failure to pay any unpaid bat n consideration of th ipt of goods and services by said firm, the undersigned do contractually and personally guarantee all payments, interest and fees by said firm i t o a/15, col ection y unpaid balances. I have read and understand these terms set forth within this account application and fully agree to the terms and conditions. Authorized Signature Title A14/014,j4 Date f/t1/26 0/19 Office Usc Only Carpet Salesperson#: Account # Entered By Branch Date 979 Third Avenue New York, NY 10022 • T 718-683-5100 Ext# 7136 • F 718-784-0731 • E • • 111/2014 EFTA00525149  trees York Stele Department of Taxation and Finance Safes Tex Regisbabon WA Harriman Carpus Abany NY 122274865 a. JSC INTERIORS, LW CIO RICHARD KAHN, MANAGER 575 LEXINGTON AVE FL 4 NEW YORK NY 10022-6146 New York Stale Department of TaxatiOn and Finance Certificate of Authority VALIDATED r Identification number 47.2294796 1 12/4/2014 (Use th. 5s number on al ralurns'and correspondence) Dept of Tax and Finance JSC INTERIORS, LLC C/O RICHARD KAHN, MANAGER 575 LEXINGTON AVE FL 4 NEW YORK NY 16022:6146 is authorized to collect sales and use taxes under Articles 28 ono 29 of the Nay York Slate Tax Law. Nontransferable This certificate must be prominently displayed at your place of business Fraudulent or other improper use of this certificate will cause it to be revoked The certificate may not be photocopied or reproduced. 4020109100098 IDES - 3390635 F0000053. 01 DTF-17-A111114/ EFTA00525150