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A0WA.tot7iotjve Drstributors Warehotise <br />NEO I SO <br />The information provided in this application is for the purpose of extending credit to our Governmental Entity. To the best of our <br />knowledge and belief, the information is accurate and may be relied upon in making your credit decision. We authorize our bank and <br />suppliers to furnish you any information necessary to complete your evaiuation of our credit history. TERMS: All accounts balances are <br />due by the 25th of each month. Those accounts which become past due wili be charged a finance charge of 1.5% equal to 18% annually. <br />Those accounts which become more than 30 days may be put on cash terms until the account is paid in its entirety. <br />SIGNATURE INDICATES AGREEMENT TO THE ABOVE TERMS AND CONDITIONS <br />SIGNATURE TITLE <br />PRINTED NAME DATE <br />STATE OF <br />DEPARTMENT OF TAXATION <br />BLANKET CERTIFICATE OF EXEMPTION <br />The undersigned hereby claims exemption io purchases of <br />tangible personal property from AUTOMOTIVE DISTRIBUTORS <br />CO., INC. on or aHer and certifies that this <br />claim is based upon the purchaser's proposed use of the items <br />purchased, the activity of the purchaser, or both, as shown <br />hereon: <br />PURCHASER MUST STATE STATUTORY REASON FOR <br />CLAIMING EXEMPTION OR EXCEPTION. <br />This certificate shall continue in force until revoked and shall be <br />considered a paR of each order given to the above named vendor <br />unless the order specifies othervvise. <br />Purchaser's Name <br />Purchaser's Activity (I.E. Manufacturer, Public Utility, Church, etc.) <br />Purchaser's Address <br />City, State, Zip Code <br />By - Signature and Title <br />Date Signed <br />aCL2266936 vln <br />Vendor's License Number, if any <br />FOR OFFICE USE ONLY <br />? SERVICING WAREHOUSE <br />? SALES REP NAME <br />I <br />CUSTOMER NUMBER <br />CITY CODE <br />? SERVICE MANAGER <br />o A \ P CONTACT <br />? LEAD TECHNICIAN <br />o PARTS MANAGER <br />? SALES REP NUMBER <br />? ACCT TYPE <br />a TERMS <br />? PRICE SCHEDULE <br />CREDIT LIMIT <br />INVOICE TYPE <br />? P 8 A CODE (F-L-M only) <br />? E-MAIL ADDRESS <br />• DELIVERY ZONE <br />? PRICING EXCEPTIONS <br />APPROVED BY \ DATE ? <br />SET UP BY \ DATE ? <br />* TO BE COMPLETED BY ADW SALESPERSON <br />REVISED 7110103 <br />-13- <br />Northeasi Ohio Sourcin . Off?ice 5t22 E:ist )Gth St. 5uiic 150 ) 216.581.6200 H?«ti•.ncoso.org ? I Clcveland, O}-I 44125 ? f ? 216.581.6213 <br />