New Customer Credit Application Form

As an officer of the above-named company (the "Customer"), I authorize Wieland to investigate Customer's creditworthiness from all available sources at any time, provided that Customer shall have the right to terminate said approval at any time. Customer promises to pay for all purchases in accordance with Wieland's Standard Terms and Conditions of Sale. The applicable Wieland Standard Terms and Conditions of Sale will apply. Customer also agrees that any disputes arising out of this Agreement or goods and merchandise ordered or delivered pursuant hereto shall be governed by the laws of the State and shall be settled in a court. Customer also agrees to share any and all financial information needed by Wieland in order to establish and maintain an open account with Customer.

Default: In the event Customer fails to abide by or adhere to any of the credit terms granted to it by Wieland, Customer shall be in default and breach of this Agreement. Customer hereby waives any written notice or demand of any default or breach.

By signing this application, I acknowledge that I have read and understand Wieland's Standard Terms and Conditions of Sale and agree to abide by them, all the above information is true and correct, I have full authority to sign this Agreement and to request that credit be granted and that no other permission or grant of authority is necessary, and this constitutes a binding and enforceable agreement.
Digital Signature: