Black Clover Credit Application

Address: 12059 S. State Street Ste. 40 Draper, UT 84020 Telephone : (801) 716-4477

Credit Terms Option

Applicant (Business Name as show on Income Tax return)

Type of Business

LLC

S-Corp

Corp

DBA (Please type your DBA on the "Other" line)

State or Territory of Business Registration

Resale/ Exempt Tax #

Please email a copy of your Resale/ Exempt Tax certificate to orders@blackcloverusa.com

Please attach a completed, current W-9

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Buyer's Email

Buyer's Phone Number

Account Payable Phone Number

Account Payable Email

Account Payable Contact (Optional)

Account Payable Phone Number (Optional)

Account Payable Email (Optional)

Shipping Contact

Resale Certificate Number

Trade Reference #1

Trade Reference #1 - Point of Contact

Trade Reference #2

Trade Reference #2 - Point of Contact

Trade Reference #3

Trade Reference #3 - Point of Contact

IN CONSIDERATION of the extension of credit to the above named Applicant, and to induce the extension of credit to the limit stated, the undersigned does hereby acknowledge and confirm to Black Clover (hereafter called Company) that they have authority from, and are acting as a representative of, the named Applicant to sign this credit application on behalf of the Applicant, whereby Applicant is agreeing and promising to pay all amounts owed on invoices for product ordered within the terms stated on the invoice (which terms are 2% 10, net 30 (meaning there is a 2% discount if the invoice is paid in full within 10 days, otherwise the full amount without an ‘early-pay’ discount is due within 30 days, from the date of the invoice) unless otherwise specified), and to pay a service charge of 1.5% per month, which is an annual percentage rate of 18%, on all overdue balances.

I have read and agree to the above terms (Check and Type Name)

The Applicant further agrees and acknowledges that this Agreement shall be governed by, and construed in accordance with, the laws of the State of Utah. Applicant further agrees and acknowledges that failure to pay amounts owed within the terms stated on the invoices or as otherwise agreed to in writing, is a breach of the parties’ agreement as stated herein, and agrees to pay any and all reasonable costs incurred for the collection thereof, whether or not legal action is instituted for collection thereof, and if action is instituted for collection, Applicant agrees and consents to pay such reasonable attorney fees as the court may award, including any attorney fees on appeal, court costs, and any/all reasonably-incurred related costs and expenses, as well as pre-judgment and post-judgment interest on such award, judgment, or settlement, and also agrees and consents that all legal proceedings shall take place in Salt Lake County, State of Utah, and therefore agrees and consents to the jurisdiction of the Salt Lake County, State of Utah courts and venue of Salt Lake County, State of Utah, whether subject-matter or personal jurisdiction, for any and all legal matters related hereto, and all legal action necessary for collection of unpaid balances. Applicant therefore hereby waives all rights to contest any court proceeding related hereto, on the grounds of lack of personal jurisdiction, venue, and/or forum non-convenience or other rules or claims of conflict.

I have read and agree to the above terms. (Check and Type Name)

Title or Position of Signee

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

By signing this agreement, Signer is stating they are an authorized agent for Applicant and that they have authority to bind Applicant to this legally-binding Agreement with Black Clover.

Signature Date