EFTA00525201.pdf

STARK CARPET FABRIC WALLCOVERING FURNITURE CONFIDENTIAL ACCOUNT APPLICATION ALL NEW ACCOUNTS ARE PROFORMA ACCOUNTS 979 Third Avenue New York, NY 10022 Credit Department Tell, 212-752-9000 Ert. 7136. Faxil 718-784-0731 COMPANY INFORMATION Company Name LTSC,I4e4ioas LAC Contact ghb,4ed /6 14/ 4 Years in Business At' Billing Address 575 Lett;142IN eg-ve , Plan_ City NY State Air Zip 100 02a Phone Fax Email Bank Referenceka-sate bAW-Account Bank Contact Sje t,"4-ft# 01,46,k Phone Tyne of Business:[?(Interior Designer • t_ Architect • I. Specifier • ii Purchasing Agent • L Hospitality • r Contract • Other Dun & Bradstreet* OWNER INFORMATION (Must be completed for all partnerships and sole proprietorships) Check One: I: Corporation • OCLLC • lL Partnership • Li Sole Proprietorship • Owners Full Name Toipi Giono Skp4m'w4 SS# Federal ID # Owners Address, Zek,*„..4e, V' A te_ City Ai/ State (Y V Zip /00 4,2,) Partners Full Name ( If Partnership ) SS* Partners Address City State Zip TRADE REFERENCES 1. Name bttthent gulwkte Phone Account* Address City State Zip 2. Name Mt+ Phone goo— bLIS-9068 Account* Address City State Zip 3. Name Phone Account* Address City State Zip I authorize Stark Carpet Corp. to con I 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 'h% per % per annum) for all np id past due invoices I also agree to pay reasonable costs of collection, including attomey'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 aif5t 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 Mili 12 / 91/4 Date 7 itibp/6 Office Use 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 • vomystarkcarpacom • ito2014 EFTA00525201  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/ EFTA00525202