General Information

Trade Name:

Please check one

Address:

Corporation:

City: State: Zip:

Partnership:

Country:

Proprietorship:

Phone: Fax:

State of Registration:

Company Information

Name of Principle Officers, Partners or Proprietors

Line of Business:

Name:

Title:

Date Established:

Name:

Title:

Estimated Annual Sales:

Name:

Title:

At present Location Since:

Name:

Title:

Federal Tax No (EIN):

Name:

Title:

Credit Card Information

Name on Card:

Card #:

Billing Address:

Expiration Date:

Billing City:

CVN:

State: Zip:

Please check: Visa �  Mastercard � 

Billing Phone:

The terms and conditions appearing below are an integral part of this agreement between the Customer and Redfish Riviera, LLC hereinafter referred to as RR.

1. Sales Tax will be charged unless a properly executed Sales Tax Exemption certificate is filed with RR

2. All sales are final and no merchandise may be returned unless a Return Authorization is furnished by a RR employee. If the return is approved, the Customer shall pay the cost of the return and any restocking fee imposed unless the charges are otherwise waived by a RR employee.

3. Customer agrees to pay all invoices Net 30 days. Invoices unpaid thirty one (31) days after the invoice date will be charged to the credit card on file and shall be subject charge of 1.5% per month of month thereof or maximum rate if said contract rate is deemed legally excessive.

4. Customers shall pay all costs of collection by RR of sums due for merchandise an/or services including the principle sum, interest thereon, attorney�fs fees for collection of 15% of the total amount due but not less than $500.00 and cost of suit.

5. Customer hereby certifies that all information provided is true. Customer hereby agrees to all of the foregoing terms and conditions, intending to be legally bound hereby.

6. RR requires a valid credit card to be on file at all times.

Signed By:_______________________________Title:__________________________________

Print Name:______________________________ Date:__________________________________

Redfish Riviera, LLC - P.O. Box 9927, Panama City Beach, Florida 32417 - Telephone. (850)230-1053       Email. redfishriviera@knology.net