DNJ ENGINE COMPONENTS, INC

www.enginecomponents.com Page 1 of 2
APPLICATION FOR CREDIT
8960 LURLINE AVE
CHATSWORTH, CA 91311
PHONE: (800) 981-7625 FAX: (818) 718-0588

How Applied: Phone In Person Mail Fax

DATE

Business Name _________________________________________________________Phone # ( )______-_______

Fax # ( )______-_______

Mailing Address ___________________________________________________________________________________

(Street) (City) (State) (Zip Code)

Shipping Address __________________________________________________________________________________

(Street) (City) (State) (Zip Code)

E-mail Address _____________________________________________________________________________

Web Site __________________________________________________________________________________

FEDERAL TAX I. D. NUMBER ______________________________________________________________________

State Resale Number ________________________________________________________________________________

Former Business Address (If Applicable) ________________________________________________________________

Type of Business __________________________Date Established__________How Long in Business? ______________

OWNERSHIP: Proprietorship Partnership Corporation Limited Liability Corp.

PRINCIPAL: _____________________________________________________________________________________
(Name) (Title) (DL #) (SS #) (Home Address)

PRINCIPAL: _____________________________________________________________________________________
(Name) (Title) (DL #) (SS #) (Home Address)

PRINCIPAL: _____________________________________________________________________________________
(Name) (Title) (DL #) (SS #) (Home Address)

PRINCIPAL: _____________________________________________________________________________________
(Name) (Title) (DL #) (SS #) (Home Address)

TRADE REFERENCES: (Name Suppliers of Major Products And Services)

NAME ADDRESS PHONE ACCT. # FAX #

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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 APPLICATION FOR CREDIT (Cont.)
Page 2 of 2
BANK REFERENCE: Checking Loan Savings

_________________________________________________ _____________________________________________
(Name) (Address) Acct. # (Contact)

_________________________________________________ _____________________________________________
(Name) (Address) Acct. # (Contact)

_________________________________________________ _____________________________________________
(Name) (Address) Acct. # (Contact)

Person to Contact About Account: ______________________________________ ___________________

(Name) (Title)

No. of Employees ___________Est. Annual Sales $ __________Sales Area ____________________________________

Has The Firm or Any of Its Principals Ever Been Bankrupt? Yes No

If Yes Explain: _____________________________________________________________________________________

__________________________________________________________________________________________________

Mortgage Holder/Landlord ___________________________________________________________________________

Address ______________________________________________________________ Phone _______________________

OTHER BUSINESS DEBTS

NAME ADDRESS BAL. DUE

____________________________________ __________________________________________ _____________________

____________________________________ __________________________________________ _____________________

The undersign will/will not submit a financial statement. Any misrepresentation in this application will be considered evidence of a
fraud, since this information is the basis for the granting of credit.

As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to
investigate the credit references listed.

PERSONAL GUARANTEE

In consideration of credit being extended by DNJ ENGINE COMPONENTS, INC. to the above named applicant for merchandise to be
purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation or other entity, the undersigned
guarantor or guarantors each hereby contract and guarantee to DNJ ENGINE COMPONENTS, INC. the faithful payment, when due, of all
accounts of said applicant for the purchases made within five years next after the date of this application. The undersigned guarantor or
guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment,
and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or
with respect to any security held by DNJ ENGINE COMPONENTS, INC. extension of time of payment to applicant, acceptance of partial
payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand
for payment under this guarantee. Absent written permission by creditor, this personal guarantee may not be revoked.
This guaranty shall be construed under and governed by the laws of the State of California. The undersigned consents to the personal jurisdiction of the Federal and State Courts
located in the State of California, waives any argument that such a forum is not convenient, and agrees that any litigation relating to the guarantee shall be venued in either the State
or Federal courts in the State of California.

_________________________________________________ _____________________________________________
(SIGNATURE) (Print Name) (Title)

_________________________________________________ _____________________________________________
(SIGNATURE) (Print Name) (Title)
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