Africa Imports Credit Application
To apply for credit with Africa Imports, please print out the enclosed form; print it out; and return it signed to:  Africa Imports  55 Green Street  Hackensack  NJ  07601

Name of Individual applying for Credit:  ___________________________________________

Employer:______________________________________________            Self Employed  (  )

Business Address: _________________________ Home Address: _______________________
                              _________________________                           _______________________
                              _________________________                           _______________________

Mailing Address (if different than Company address)___________________________________
                                                                                  ___________________________________
Federal tax ID # ______________________Social Security Number: _____________________
List Three ( 3 ) trade References at least 6 months old (do not list banks or major credit cards).

1. Name _______________________
   Address______________________
2. Name _______________________
   Address______________________
3. Name _______________________
   Address______________________

Banks you do business with:
1.  Name _______________________
     Address______________________
2.  Name _______________________
     Address______________________

Date Account Opened: ______________
Phone Number: ____________________
Date Account Opened: ______________
Phone Number: ____________________

1. _____________________________   2.   ________________________________________
3. _____________________________   4.   ________________________________________
Do you require a Purchase Order #:  (  ) Yes,   (  ) No
All accounts are due and payable by the 10th of the month.  It is understood that any account not paid in 30 days will carry a 2% service charge. APR 24%.  It is also understood that all accounts will be COD if an account is 30 days or more past due.   By completing and returning this Request for Credit, I hereby give permission for Africa Imports to obtain my consumer credit report in connection with the extension of credit; and also to verify any information furnished.  I understand that the credit report is furnished by a credit reporting agency, and that the name and phone number of the agency can be provided to you if denied credit because of information contained in the report.

Date:  ___________________  Signature:  

 _________________________________________
                                                   Title:   ____________________________________________