Please complete this Credit Application form in its entirety. After carefully reading and agreeing to the Credit Application and Terms and Conditions (all 5 pages), sign the last page of this document. Your application will be reviewed by Los Angeles Apparel, Inc. (hereinafter “Los Angeles Apparel” and/or “Seller”) and if approved, the Terms and Conditions set forth below will control. Please scan and email all completed and signed pages to newaccounts@losangelesapparel.net

Applicant Information

Terms: Open Account Company Check

ASI#:

Contact Name:

Company Name:

Phone:

Fax:

E-mail:

Registered Company Address:

City:

State:

Zip:

State Resale License Number:

Is Applicant Tax Exempt?:

Federal Tax ID:

Driver's License #:

DUNS #:

Type of Business: Sole proprietorship Partnership Corporation Other

Names of Individuals, Owners, Partners, Officers

#1

Name :

Phone :

Title :

Address:

City :

State :

Zip :

#2

Name :

Title :

Phone :

Address:

City :

State :

Zip :

#3

Name :

Title :

Phone :

Address:

City :

State :

Zip :

#4

Name :

Title :

Address:

Phone :

City :

State :

Zip :

Banking Information (Complete or attach reference sheet)

Bank Name:

Bank Account:

Name of Bank Contact:

Phone:

Fax:

Bank Address:

City:

State:

Zip:

Fax:

Type of Account: Checking Savings Other

Trade Reference

#1

Name:

Account:

E-mail:

Address:

City:

State:

Phone:

#2

Name:

Account:

E-mail:

Address:

City:

State:

Phone:

#3

Name:

Account:

E-mail:

Address:

City:

State:

Phone:

#4

Name:

Account:

E-mail:

Address:

i City:

State:

Phone:

Credit Card Information

Card Holder Name:

Credit Card #:

Type:

Expiry:

CVV:

Billing Address for Credit Card:

City:

State:

Zip: