BUSINESS CREDIT APPLICATION

CUSTOMER NAME_______________________________________________________________

STREET________________________________________________________________________

CITY___________________________________STATE___________ZIP____________________

PHONE_____________________________FAX________________________________________

FEDERAL I. D. #_________________________________________________________________

IF TAX-EXEMPT: TAX I.D. # ______________________________________________________

CHECK ONE: (  ) CORPORATION-DATE OF INCORPORATION_________________________

                            STATE OF INCORPORATION_______________________________________

                      (  ) PARTERSHIP-DATE STARTED______________________________________

                      (  ) SUBSIDIARY OR (  ) DIVISION OF___________________________________

                (  ) SELF-EMPLOYED_________________________________________________

                               SOC. SEC.#__________________________________________________

                      (  ) OTHER - SPECIFY_________________________________________________

HOW LONG IN BUSINESS_________________________________________________________

SPOUSES NAME(IF NOT INCORPORATED)__________________SOC.SEC.#______________

TRADE REFERENCES:

NAME________________________________       NAME_________________________________

ADDRESS_____________________________       ADDRESS______________________________

______________________________________        _______________________________________

PHONE_______________________________        PHONE_________________________________

FAX__________________________________        FAX___________________________________

NAME________________________________        NAME_________________________________

ADDRESS_____________________________       ADDRESS______________________________

______________________________________        _______________________________________

PHONE_______________________________        PHONE________________________________

FAX__________________________________        FAX___________________________________    

BANK REFERENCES:        WE MUST HAVE ACCOUNT NUMBERS.

NAME________________________________        NAME_________________________________

ADDRESS_____________________________        ADDRESS______________________________

______________________________________         ______________________________________

PHONE_______________________________          PHONE_______________________________

ACCOUNT #___________________________         ACCOUNT #___________________________

I FIND THIS CREDIT APPLICATION TO BE CORRECT AND IN THE EVENT  THAT THIS

ACCOUNT IS NOT PAID AND IS REFERRED TO AN ATTORNEY FOR COLLECTION, I

UNDERSTAND, THE ABOVE COMPANY IS TO PAY NOT ONLY REASONABLE ATTORNEY

EES AND COST OF COLLECTION, BUT ALSO COURT COSTS.

SIGNATURE_____________________________________________________________________

TYPE NAME_____________________________________________________________________

TITLE___________________________________________________________________________

DATE___________________________________________________________________________