2450 North Powerline Road, Suite # 1
Pompano Beach, FL 33069-1051
Ph: 954.960.0311 • Fax: 954.960.0533
Thank you for requesting a credit application and your interest in opening a charge account. We
appreciate your interest and will begin processing your application upon completion. Upon approval you
will be notified as to when you may begin using the account.
Payment is due Net 30 days from invoice date.
The following must be filled out completely in order to process the application.
Please provide complete information in ALL sections.