APPLICATION FOR CREDIT

INCOMPLETE AND/OR UNSIGNED

APPLICATION WILL NOT BE PROCESSED

PONTE ATLANTICO INC., DBA CHRISTOPHERLENA

TEL: 310-327-0050 FAX: 310-323-0109

PLEASE TYPE OR PRINT.

Corporate Name

DBA

Billing Address

City, State, Zip

Shipping Address

City, State, Zip

Phone Number #

Fax #

Cell #

Primary Contacts- Buyer

Account Payable

Resale's Card #

Ownership: Corporation

Date Business Began

Partnership

D & B #

Sole proprietor

List below the name of Officers, Partners and / Sole Owner

Name

Address and Phone

Title

BANK REFERENCE - COMPLETE INFORMATION REQUIRED

Name of Bank

Acct #

Address

Officer

City, State, Zip

Phone

Trade Reference - Address Required

Corporate Name

DBA

Address

City, State, Zip

Phone Number

Fax

E-mail

Cellular #

Primary Contacts

Account Payable

Corporate Name

DBA

Address

City, State, Zip

Phone Number

Fax

E-mail

Cellular #

Primary Contacts

Account Payable

Corporate Name

DBA

Address

City, State, Zip

Phone Number

Fax

E-mail

Cellular #

Primary Contacts

Account Payable

Corporate Name

DBA

Address

City, State, Zip

Phone Number

Fax

E-mail

Cellular #

Primary Contacts

Account Payable

Corporate Name

DBA

Address

City, State, Zip

Phone Number

Fax

E-mail

Cellular #

Primary Contacts

Account Payable

It is deemed that all sales originate in Carson, California. You are hereby authorized to obtain any information you consider necessary

concerning this application. The undersigned promises to pay for all purchases in accordance with your terms of sale. If it becomes

necessary for your business to incur collection costs for any amount due under this agreement, the undersigned agrees to pay all collection

costs including attorney fees. Upon acceptance by Ponte Atlantico, Inc. This application constitutes a sales and purchase agreement.

I declare the information contained in this application to be true and correct.

SIGN

TITLE

DATE