Ben Hogan Golf Equipment Company, LLC

685 John B. Sias Memorial Parkway, Ste 515 | Fort Worth, TX 76134 | 1-844-53Hogan | www.BenHoganGolf.com

Ben Hogan Golf Collegiate Partner Information/Credit Application

Primary Contact Phone Number Email Address

College/University Federal ID #

Coach/Instructor Email Address

Business Address Phone Number

College / University Information

Type of College or University (Choose One)

! State ! Private ! Junior College

Division

Date Established

D&B D-U-N-S State of Corp Fed ID #

Athletic Conference

Business Address Bill to Address Ship to Address

Phone Number

Fax Number

Trade References (Please complete both trade references)

Company Name Company Name

Contact Name Contact Name

Address

Address

Phone Phone

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Additional information may be requested if needed. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

______________________________________________________________________________Authorized Account Signature Printed Name Date