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Personal Mosquito Repeller
Bug Repeller Light
 
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Multifunctional Pest Repeller
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Solar Cat Repeller
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Solar Deer Repeller
Solar Fox Repeller
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Bark Control & Trainer
 
Toothbrush Sanitizers
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Air Sanitizers & Air Purifiers
Air Sanitizer, Air Cleaner & Deodorizer CFL Bulbs
Plug-In Ionic Air Purifier & Deodorizer with night light (US)
Plug-In Ionic Air Purifier & Deodorizer with night light (EU)
 
Hand Odor Remover
Chemical Free Hand Deodorizer
 
First Aid Kit
 
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FAX Credit Application Form

Please print out this form, fill out completely and fax to GOVATIONS at:
(770) 667-8683.

 Name_________________________________________________________
Title_________________________________________________________
Company_________________________________________________________
Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________
FAX_________________________________________________________
E-mail_________________________________________________________

PRINCIPALS (if corporation, list officers, if partnership, list partners)

1. Name_________________________________________________________
Title_________________________________________________________
Home Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________

---------

2. Name_________________________________________________________
Title_________________________________________________________
Home Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________

----------

3. Name_________________________________________________________
Title_________________________________________________________
Home Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________

SALES TAX STATUS (Please check one)

Not Tax Exempt____
Tax Exempt ____ Tax Exempt Number__________________

BANK REFERENCE

Bank Officer_________________________________________________________
Bank Name_________________________________________________________
Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________
Account #_________________________________________________________

TRADE REFERENCES

1. Contact Name_________________________________________________________
Company_________________________________________________________
Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________

----------

2. Contact Name_________________________________________________________
Company_________________________________________________________
Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________

----------

3. Contact Name_________________________________________________________
Company_________________________________________________________
Address_________________________________________________________
City_________________________________________________________
State_________________________________________________________
Zip_________________________________________________________
Country_________________________________________________________
Phone_________________________________________________________

BUSINESS INFORMATION

Individual ____
Partnership ____
Corporation ____
Type of Business___________________________________
Number of Employees________________________________
Years in Business__________________________________
Annual Sales $_____________________________________
D+B Listed? Yes____ No____
Amount of Credit Requested $ ______________________

BY COMPLETING THIS APPLICATION FOR CREDIT, THE APPLICANT:

1. Attests financial responsibility, ability and willingness to pay all invoices
in accordance with the following terms: 2% 10; Net, 30 days, service charges will be
paid at the rate of 1.5% (18% annual rate) on all balances over 30 days.

2. Hereby Authorizes GOVATION. to investigate
the references listed pertaining to the applicant's credit and financial responsibility and
obtain additional information by securing data from a credit reporting agency.

3. Hereby Agrees that should it become necessary to assign the applicant's
account to a licensed collection agency or atttorney for legal action, all subsequent
collection charges and legal fees shall be paid by the applicant.

4. Hereby Authorizes the seller, its successors and assigns, by the seller's
designated attorney to waive the issuance of process and confess judgment against the
applicant for the entire unpaid balance of applicant's account together with all costs
applicable to such action.

5. Certifies and Warrants that the information given in this application is true and
correct and is given for the purpose of obtaining credit.

Applicant Name________________________________________
Position____________________________________
Date________________
Applicant Name________________________________________
Position____________________________________
Date________________