Retail Store

Statement of Authorization

This application is being executed by the undersigned as a duly authorized representative (corporate officer or owner) of the customer and the undersigned certifies all information on this form is true and correct. The customer agrees to pay all invoices per their terms and to pay all other charges on account, including, without limitation, collection costs, attorney fees, and court costs. Nothing herein shall obligate the seller to accept any orders from, or extend any credit to the customer. All obligations are governed by, and shall be construed under, the laws of the State of Illinois without giving effect to the laws of such State regarding conflicts. The customer, by the undersigned, irrevocably submits and consents to the jurisdiction of courts located in Cook County, Illinois.