Credit Application

Credit Application and Purchase Agreement (C.O.D.) Fax to 801.303.6285

(Please Type or Print Legibly)

BUSINESS NAME	TELEPHONE	FAX
1

ADDRESS	CITY	STATE	ZIP
1

DATE BUSINESS BEGAN	CORP/PTNSHP/SOLE PROP	AMOUNT OF CREDIT DESIRED	GROSS ANNUAL SALES LAST FISCAL YEAR
1

BANK REFERENCES

Bank Name	Contact	Phone
1

Address	Acount Number
1

FULL NAME, HOME ADDRESS AND HOME PHONE #'S OF PRINCIPAL OWNERS/OFFICERS/GENERAL PARTNERS

1. Name	Title	Phone
1

Address

2. Name	Title	Phone
1

Address

3. Name	Title	Phone
1

Address

MAJOR SUPPLIERS (at least three)

1. Name	Accounting Contact	Phone
1

Address	Fax
1

2. Name	Accounting Contact	Phone
1

Address	Fax
1

3. Name	Accounting Contact	Phone
1

Address	Fax
1

4. Name	Accounting Contact	Phone
1

Address	Fax
1

PARTIES HEREBY AGREE THAT ALL PURCHASES MADE ARE SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS : 1. The undersigned purchaser herby agrees to the General Terms and Conditions of Sale.

2. Applicants signatures attest financial responsibility, ability and willingness to pay invoices in accordance with stated term.

3. To induce OneOff Media, Inc. to extend a line of credit for purchases under credit sales terms as stated on invoices, the undersigned authorizes OneOff Media, Inc. to extend a line of credit for purchases under credit sales terms as stated on invoices, the undersigned authorizes OneOff Media, Inc. to contact the references and banks listed above, consumer credit reporting agencies and commercial credit reporting agencies. This information will be held in strict confidence and used solely for the consideration of extension of credit.

NAME	SIGNATURE	DATE
1

PERSONAL INDEMNITY AND GUARANTEE To induce OneOff Media, Inc. to approve this credit application and purchase agreement and in consideration of its so doing, we, the undersigned, do hereby jointly, severally and personally guarantee the above individual, Corporation or Partnership Purchaser's full performance of said Purchase Agreement and hereby agree to indemnify OneOff Media, Inc., against any and all damages, loss, expense (including attorney's fees) and/or liability sustained by OneOff Media, Inc. by reason of, or related to, the above Purchaser's failure to perform or to pay when due, charges incurred in accordance with the above Agreement. The above Purchase Agreement may be modified by OneOff Media, Inc. and the Purchaser executing same without notice to the undersigned and without affecting this indemnity and Guarentee. OneOff Media, Inc. may enforce this Agreement against the undersigned or any of them, jointly or severally, whether or not any action is ever taken by it against the above named Purchaser.

NAME	SIGNATURE	DATE
1

Fax to 801.303.6285