| LaBatteries

For Cash or Credit Card Account, Skip to Step 4

Terms and Conditions:

LaBatteries Standard Terms: Net 10th (Total statement balance by the 10th of the following month). No Discounts. I/ We hereby authorize LaBatteries to investigate the above references and to access any and all credit reporting agencies regarding my/ our credit background and financial responsibility. Applicants signature warrants: (a) ability and willingness to pay invoices in accordance with LaBatteries Standard Terms (b) Agreement to pay a service charge of up to 2% per month added to accounts 30 days or more past due, and (c) Agreement to pay all reasonable cost of collection including a reasonable attorney's fee if the account balance is not paid when due.

Agree to Terms and Conditions If Applying For Credit

1. Credit References (2)

2. Accounts Payable Contact

Accounts Payable Email

3. Do You Use Purchase Orders?

Yes

4. Type of Business

5. Corporation Name

6. Business Name *

7. Billing Address *

8. Physical Address *

9. Phone Number *