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BUSINESS CREDIT APPLICATION

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Business Name__________________________________Date______________

Address______________________City__________State_________Zip_____

Owner/Manager_______________________________Tel.No.______________

How long in business________________________D & B Rated__________

Trade References:

Name_______________________________Address_______________________

Name_______________________________Address_______________________

Name_______________________________Address_______________________

Name_______________________________Address_______________________

Bank References:

Name_______________________________Address_______________________

Name_______________________________Address_______________________

Credit line requested $_________________________________

Pending lawsuits against Company:

___________________________________________________

___________________________________________________

___________________________________________________

The undersigned authorizes inquiry as to credit information. We further acknowledge that credit privileges, if granted, may be withdrawn at any time.

_______________________________

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