Date ___________                Phone ______________________________________________

Name of firm or corporation ______________________________________________

Billing Address _______________________________________     For Past ___ years

City ________________________ State ________________ Zip Code _________________

Shipping Address ____________________________________________________________

D/B/A _____________________ Federal tax ID number _______________________

Former Business Address (If Applicable) _____________________________________

Type of Business _________ Date Established _______ How long in business ________

Does State, County or City require a license? Yes No License # _______________

Ownership: Sole Owner Partnership Corporation

Principal: ___________________________________________________________________
                           (Name)                      (Title)                    (Phone #)

Principal: ___________________________________________________________________
                           (Name)                      (Title)                    (Phone #)

Principal: ___________________________________________________________________
                           (Name)                      (Title)                    (Phone #)

Trade References: (Name of major products and services)

             NAME                                     ADDRESS                                  PHONE

_________________________   _________________________________  ____________________________

_________________________   _________________________________  ____________________________

_________________________   _________________________________  ____________________________

Bank Reference:   Checking  Loan  Savings                                          

___________________     _______________________________    ________________   __________________
      (Name)                      (Address)                                 (Acct #)            (Contact)

___________________     _______________________________    ________________   __________________
       (Name)                      (Address)                                (Acct #)             (Contact)

No. of Employees ________ Est. Annual Sales $_______ Sales Area _________

Has the firm or any of its Principals ever been bankrupt? Yes No

If Yes, Explain:_____________________________________________________________________

_______________________________________________________________________________________

Other Business Debts

Name                                      Address                                              Balance Due

_______________________     _____________________________________       _______________

_______________________     _____________________________________       _______________

_______________________     _____________________________________       _______________

Person to Contact About Invoices:

___________________________________________________________________________________________
(Name)                           (Title)                           (Phone #)                          (Fax#)

The undersigned will/will not submit a financial statement. Any misrepresentation in this
application will be considered evidence of a fraud, since this information is the basis
for the granting of credit.

As an inducement to grant credit, the undersigned warrants that the information
submitted is true and correct. You are authorized to investigate the credit references
listed.

Signed:____________________________________________________________

Title:__________________________________ Date:________________________

PERSONAL GUARANTEE »

In consideration of credit being extended by ______________________________
to the above named applicant for merchandise to be purchased whether
applicant be an individual or individuals, a proprietorship, a partnership,
a corporation, or other entity, the undersigned guarantor or guarantors
each hereby contract and guarantee to ________________________ the faithful
payment, when due, of all accounts of said applicant for the purchases
made within five years next after the date of this application. The
undersigned guarantor or guarantors, each hereby expressly waive all notice
of acceptance of this guarantee, notice of extension of credit to applicant,
presentment, and demand for payment on applicant, protest and notice to
undersigned guarantor or guarantors of dishonor or default by applicant
or with respect to any security held by __________________________, extension of
time of payment to applicant, acceptance of partial payment or partial
compromise, all other notices to which the undersigned guarantor or
guarantors might otherwise be entitled and demand for payment under
this guarantee. Absent written permission by creditor, this personal
guarantee may not be revoked.

_______________   _____________    ______________     _____________________________________
       (Name)                    (Title)                         (SS#)                                       (Home Address)

CREDIT DEPARTMENT USE ONLY »

Date Line of Credit Approved: __________

Date Line of Credit Denied: ____________

Comments __________________________________________________________

In consideration for credit being extended, I or we acknowledge and agree the following: (1) Payment is jointly, severally and
unconditionally guaranteed within 30 days of date of delivery; (2) any charges unpaid after the above 30 days are to be
increased by 11/2 % per month; (3) any charges still outstanding after 90 days from the date of delivery are subject to
collection or arbitration expenses , attorney’s fees, and court costs will be borne by the purchaser; (4) title to all work
shall remain with the creditor until all invoices and additional charges have been paid in full; (5) all claims , requests for
adjustments, or notification of errors must be made within 30 days, or charges are considered accepted; (6) this agreement
shall apply to all current and future charges unless revocation is received by registered mail; (7)credit privileges may be
withdrawn at any time without invalidating the terms of this agreement.

Please print and fax this form to 330-244-8561