Mark of Fitness, Inc. 621 Shrewsbury Avenue, Shrewsbury, NJ 07702

(732) 842-7200 Fax (732) 842-0558

Legal Name______________________________			Trade Name _______________________________________
Address ____________________________________________________________________________________ ____________________________________________________________________________________
Telephone _______________________________			Fax ______________________________________________
Accounts Payable Contact _______________		Years in Business_____				Annual Sales__________________
Business Entitiy: Propreitorship ______	Partnership ______					Corporation___________________
Name and Address of Owner/Principal ______________________________________________________________
Credit Limit Requested _____________________				Federal Tax ID# ____________________________________
Primary Business (ie: retail drug store, wholesale electronics _____________________________________________
Bank References:
Bank:____________________________ _				Account#:_________________________________________
Branch:_______________________________________________________________________________________
Branch Address:________________________________________________________________________ _____________________________________________________________________________ ____
Contact:______________________________________________________________________________________
Telephone:_________________________________				Fax _________________________________________
Trade Credit References:
Vendor Name _______________________________				Vendor Name_____________________________________
Address ___________________________________ _________________________________ _				Address_________________________________________ ________________________________________ _
Account # __________________________________				Account # ________________________________________
Telephone__________________________________				Telephone _______________________________________
Fax __________________________________				Fax _______________________________________
Vendor Name _______________________________				Vendor Name ____________________________________
Address____________________________________ ___________________________________ _				Address ______________________________________ ____________________________________ ___
Account # __________________________________				Account # _______________________________________
Telephone _________________________________				Telephone ______________________________________
Fax _________________________________				Fax _______________________________________
Please fax or mail the completed form ASAP to: Credit Manager at Mark of Fitness, Inc.
This application authorizes Mark of Fitness, Inc. to contact the above references for credit information for the sole purpose of extending credit. I certify this information to be true.
Authorized Signature______________________________					Date ________/_____________/___________
Authorized Name_________________________________					Title _________________________________