PEACE TEXTILE AMERICA 1605 S. GUIGNARD PKWY

SUMTER, SC 29150 P: 803-773-2177 F: 803-773-5624

NEW CUSTOMER SET-UP FORM:

Section 1: General Information

Company Legal Name:

DBA / AKA:

Physical Address:

City: State: Zip Code: Country:

Phone: Fax:

Type of Entity: C-Corp S-Corp Partnership LLC LLP Sole Proprietorship

Year Established: Type of Business:

Federal Tax ID #: Dunn & Bradstreet #:

California Customers Only: Sellers Permit Number:

South Carolina Customers Only: Sales Tax Exemption Certificate Number:

Section 2: Billing Information

Address:

City: State: Zip Code: Country:

Accounts Payable Contact:

Accounts Payable E-mail:

Accounts Payable Phone Number:

Accounts Payable Fax Number:

Section 3: Agreement

By signing below, the applicant certifies that the information contained herein is true and correct, and further authorized Peace Textile America, Inc. d.b.a Pacific Sports, (Seller), to make any inquires necessary for verification of the information provided. The undersigned Applicant indemnifies the Seller, and its agents, from any liability resulting from their credit inquiry.

Authorized / Officer Signature:

Authorized / Officer Printed Name:

Title:

Date: