To apply to become a Northern Exposure Greeting Cards Dealer, please supply the following information. Name of Business   DBA - Doing Business As (if applicaable)   Business Billing Address Information Street Address City State Zip Country Phone Number Fax Number E-Mail Contact and Title Information Contact Person: First Name MI Last Name Title Bank Reference Bank Name Account Number Street Address City State Zip Country Phone Number Fax Number List 3 Trade References Trade Ref 1 Street Address City State Zip Country Phone Number Fax Number Trade Ref 2 Street Address City State Zip Country Phone Number Fax Number Trade Ref 3 Street Address City State Zip Country Phone Number Fax Number TIN/SS Number Resale Number Business Type and Date Established Corporation         Partnership         Sole Propietor         The business was established in what year? By submitting this information to Northern Exposure, I hereby authorize the bank and trade references listed in the credit application to release to Northern Exposure any credit information concerning myself or my company which may be requried to establish my trade credit. TERMS OF CREDIT: Invoices are Net 30 and are considered past due after 30 days. Interest of 1.5% per month accrues (18% per year) on unpaid balances after 30 days" Thank you.