Credit Application

AUTHORIZATION FOR ACH PAYMENT (OPTIONAL)

Do you wish to be setup for ACH Payments?*

Yes No

Bank Name*

Bank Transit ABA #*

Bank Account Number*

Bank Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Bank Phone Number*

Authorized Contact Name*

First Name

Last Name

Fax Number*

Phone Number*

E-Mail*

Alternate Contact Name

First Name

Last Name

PLEASE ATTACH A COPY OF A VOIDED CHECK AND RETURN WITH CREDIT AGREEMENT/APPLICATION*

No File Chosen

File uploads may not work on some mobile devices.

Customer authorizes ANDA to initiate debit entries from Customer’s account indicated above and Customer authorizes the financial institution named above (the “Institution”), to debit the same such account. Authority to initiate debit entries shall remain in full force and effect until ANDA and the Institution have received written notice from the applicant of its termination of such authorization. Customer acknowledges that it has a legal right to stop payment of a debit entry by notification to the Institution; provided, prior to such notification, Customer shall provide sufficient written notice to allow ANDA to take any necessary action to avoid disruption of payments from Customer.

Print Name*

First Name

Last Name

Title*

Authorized Signature*

[clear]

Date*

SECURITY AGREEMENT AND GUARANTY, VENUE AND JURISDICTION

Security Agreement

Company, in consideration of the credit being extended to Company as well as any future credit described in this Agreement, agrees to pledge, assign, transfer, deliver and grant ANDA a security interest in, a lien upon, and a right of set off and/or recoupment against, any and all of its existing and future right, title and interest in Company’s accounts receivable, proceeds thereof, and any other real and personal property of the Company as described in the relevant security agreement, and to execute any document required by ANDA to provide for such security interest, including but not limited to executing a separate security agreement in the form acceptable to ANDA. This security interest is granted to ANDA to secure the payment of the Obligations as well as any default interest or fees set forth herein as well as any other indebtedness Company owes ANDA as well as any future advances of credit including all renewals, extensions, and modifications of this Agreement.

Guaranty, Venue and Jurisdiction

In consideration of credit being extended to Company by ANDA, the receipt and sufficiency of which is hereby acknowledged, and to induce ANDA to extend the credit herein, each individual below (each, a “Guarantor” and collectively, the “Guarantors”), jointly and severally, personally guaranties the full, prompt and complete payment and performance of Company under this Agreement. If ANDA elects to enforce its rights against less than all Guarantors, that election shall not release any Guarantor from his or her obligations under this Agreement. The compromise or release of any of the obligations of any of the other Guarantors or Company shall not serve to waive, alter or release any Guarantor’s obligation under this Agreement. Each Guarantor agrees that this guaranty is an absolute, complete and continuing guaranty of performance and payment, and not of collection. Thus, ANDA may insist that any or all of the Guarantors pay immediately, and ANDA is not required to attempt to collect first from Company or any other party liable for the obligations under this Agreement. Each Guarantor waives presentation for payment, notice of non-payment, protest and notice of protest, demand for payments and diligence in bringing suit against any part hereto. No notice of indebtedness or of any extension of credit by ANDA to Company needs to be given. The terms of credit may be rearranged, extended and/or renewed without notice to any of the Guarantors. Each Guarantor represents, with Company, that all of the information submitted is true, complete and accurate. Each Guarantor agrees that should any payments to ANDA relating to this Agreement, in whole or in part, be invalidated, declared to be fraudulent or preferential, set aside and/or required to be repaid to a trustee, receiver or any other party under any bankruptcy act or code, state or federal law, common law or equitable doctrine, this guaranty shall remain in full force and effect (or be reinstated, as the case may be) until payment in full of any such amounts, which payment shall be due on demand. This guaranty, as well as all other provisions of this Agreement, shall be governed by Florida law. Each Guarantor agrees that any legal action or proceeding against him or her with respect to any of his or her obligations under this Agreement or guaranty may be brought exclusively in state or federal court located in Broward County, in the state of Florida. By the execution and delivery of this guaranty, each Guarantor submits to and accepts, with regard to any such action or proceeding, for himself and herself, and in respect of his or her property, generally and unconditionally, the jurisdiction of those courts. Each Guarantor waives any claim that Broward County is not a convenient forum or the proper venue for any such suit, action or proceeding. COMPANY AND EACH GUARANTOR HEREBY MUTUALLY, VOLUNTARILY, IRREVOCABLY AND UNCONDITIONALLY WAIVE FOR THE BENEFIT OF THE OTHER ANY RIGHT TO HAVE A JURY PARTICIPATE IN RESOLVING ANY DISPUTE, WHETHER SOUNDING IN CONTRACT, TORT, OR OTHERWISE, ARISING OUT OF, IN CONNECTION WITH, RELATED TO, OR INCIDENTAL TO THIS AGREEMENT, THE TRANSACTIONS RELATED THERETO OR THE RELATIONSHIP ESTABLISHED THEREBY. THIS PROVISION IS A MATERIAL INDUCEMENT TO ANDA TO ENTER INTO THIS TRANSACTION. IT SHALL NOT IN ANY WAY AFFECT, WAIVE, LIMIT, AMEND OR MODIFY ANDA’S ABILITY TO PURSUE ITS REMEDIES.

Name

First Name

Last Name

Date

Title

SSN

Please do not include dashes in your response (Example 123456789)

Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

Authorized Signature (Guarantor – Must be Officer, Partner or Owner)

[clear]

Name

First Name

Last Name

Date

Title

SSN

Please do not include dashes in your response (Example 123456789)

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Authorized Signature (Guarantor – Must be Officer, Partner or Owner)

[clear]

Anda Internal User Only:

Date Received

Date Completed

Reviewed By

First Name

Last Name

Current Credit Limit

New Credit Limit