Ideal Fitness, Inc. Corporate Accounts Credit Application

Ideal Fitness Inc.
P.O. Box 244582
Boynton Beach, FL 33424

Purchase Order Credit Application

Please fill out and either mail to the address above, fax it to: Corporate Accounts Manager at toll free (866) 345-3018 or to (561) 745-2183 or e-mail it to sales@shapeupshop.com.

Business Name: _______________________________________________________________________
Contact Name (Last, First): _____________________________________________________________________
Tax ID. #: ______________________________________
Business Address: _______________________________________________ Yrs: _____ Mos: ________
City: ___________________________________State: ____ Zip: __________
Telephone: (________) ___________________ Fax:: (________) ___________________

Credit References:

Contact Name: ______________________________________________________________
Business Address: _______________________________________________ Yrs: _____ Mos: ________
City: ___________________________________State: ____ Zip: __________
Telephone: (________) ___________________ Fax:: (________) ___________________
Account #: _____________________
Contact Name: ______________________________________________________________
Business Address: _______________________________________________ Yrs: _____ Mos: ________
City: ___________________________________State: ____ Zip: __________
Telephone: (________) ___________________ Fax:: (________) ___________________
Account #: _____________________
Contact Name: ______________________________________________________________
Business Address: _______________________________________________ Yrs: _____ Mos: ________
City: ___________________________________State: ____ Zip: __________
Telephone: (________) ___________________ Fax:: (________) ___________________
Account #: _____________________

I authorize the Creditor and its Assignee to make whatever inquiries it deems necessary in connection with this credit application and in the course of review or collection of any credit extended in reliance on this application. I further authorize any person or Consumer Reporting Agency to complete and furnish to the Creditor and its Assignee any information it may have or obtain in response to such inquiries, and agree that such information, along with this application, shall remain the Creditor's and Assignee's property, whether or not credit is extended. All information stated in this application is declared to be a true representation of the facts and made for the purpose of obtaining the credit requested.

Signature: ________________________________________________________ Date: _______________