AMREP INC.

APPLICATION FOR CREDIT

1 555 S. CUCA MONG A AV E.

ONTARI O, CA 9 17 61 .

BUSINESS CONTACT INFORMATION

Title Date business commenced
Company name Sole proprietorship
Phone | Fax Partnership
E-mail Corporation
Registered company Other
address
City, State ZIP Code
Federal Tax I.D. Number
BUSINESS AND BANK INFORMATION
City, State ZIP Code Bank name:
How long at current Bank address -
address? City, State ZIP Code
Phone Phone
Fax Account number
E-mail Type of account Savings Checking
Other
BUSINESS/TRADE REFERENCES
Company name Phone
Address Fax
City, State ZIP Code E-mail
Type of account Other

Company name Phone

Address Fax
City, State ZIP Code E-mail
Type of account Other

Company name Phone

Address Fax
City, State ZIP Code E-mail
Type of account Other
AGREEMENT
1. Terms will be 30 days from date of invoice unless otherwise agreed upon in writing.
2. By submitting this application, you authorize AMREP INC. to make inquiries into the banking and business/trade
references that you have supplied.
SIGNATURES

Signature Signature
Name and Title Name and Title
Date Date
CREDIT INFORMATION RELEASE
To Whom It May Concern:

Amrep Inc. has been contacted by me/us with regard to a financial transaction. You are hereby authorized to release any information
about me/us required by Amrep Inc. to complete its due diligence investigation with regard to the transaction. Such information may
include, but is not limited to, financial and credit information, consumer credit reports, and any information concerning liens and
judgments against me/us.

A copy of this authorization bearing the signature of the undersigned may be deemed to be the equivalent of the original.

Thank you.

FOR INDIVIDUALS

____________________________ ___________________________
Print Name Date
____________________________ ___________________________
Signature Social Security Number
____________________________
Telephone Number
Address:____________________________________________________

City:____________________________,State:______Zip Code:________

FOR ENTITIES

____________________________ ___________________________
Entity Name Entity Type
____________________________ ___________________________
By (Print Name) Tax Identification Number
____________________________ ___________________________
Signature Date
Address:____________________________________________________

City:____________________________,State:______Zip Code:________