Forum US Inc.

10344 Sam Houston Park Dr

Houston, TX 77064
Phone: +1 713-351-7900

Customer Application
Legal Name of Business: Global Solutions International llc Trade Name of Business: GSIPumps
Billing Address: 6248 Edgemere Blvd #518
City: El Paso State/Prov: Texas Zip/PC: 79925
Physical Address: 623 Langtry St
City: El Paso Tx State/Prov: Texas 79902
Zip/PC:
Phone No.: 9154006114 Fax No.: Contact/Owner Name: Hector Valdez
Sales Tax: ✔ Taxable ✔ Exemption Certificate (enclose copy of tax exempt certificate)
Federal Tax Identification Number: 82-4621375
Incorporated Under State Law of: TEXAS Years Established:
Type of Business: Corporation Partnership ✔ Legal Limited Corporation Proprietorship Other
Purchase Order: Required ✔ Not Required
Accounting Contact: EMILIO VALLEJO / HECTOR VALDEZ E-Mail Address: VENTAS@GSIPUMP.COM
Telephone Number: +526562716286 Fax Number:

PAYMENT METHOD
Cash: ✔
Check ✔ Wire Transfer

Credit Card: ✔ Master ✔ Visa Discover American Express

5348750005001318
Credit Card No. _____________________ 0627
Exp. Date ______________

Name On Card _____________________

GLOBAL SOLUTIONS INT. 391
Verification No.__________
Address on Card (If different from above)

ACKNOWLEDGMENT
By signing or the acceptance of this document by an authorized signor, the owner/s both individually and on behalf of the company
being referred to herein: (1) acknowledge and agree to all of the Terms (2) certify that, the signor is authorized to bind the
company and yourself/themselves individually to this agreement and application for the business named in this application
("Customer") and that all information and documents provided herein are true, correct and complete; (3) acknowledge and agree
that all owners and principals of applicant company will be personally liable for any amounts owed by Customer to the Company
and its affiliates.

Signature: Date:
10-06-22