CREDIT APPLICATION FORM                           Date Filed:

Company Information:

Company Name:                                                                                                                                            E-mail:

Address:                                                                               City:

State:                                       Zip:                                      Tel:                                                Fax:

Form of Business:                 (   )sole Proprietorship          (   )Partnership                              (    ) Corporation

Type of Business:                                                                                                                     Date Established:

Federal Employer ID#:                                                       Resale Tax ID#:

Major Product Line:                                                                             Please attached a copy of Tax Examption Certificate

City/County where the Company Registrated                                                                  Business Lisence#

Annual Sales(Last Year)                                                   Number of Employee                                      (This Line must fill)

President/Owner (The personal signed the account agreement)

Name:                                 Title:                                                                  Social Secuity No.: (must fill)        

Address:                                                                                                       (must fill)    

State:                                  Zip:                                                                     Tel:

Bill Contact and Accounts Payable Contact

Name:                                 Title:                                                                    Tel:

Address:                                                                                                          Fax:

City:                           Satae:                                  Zip:                                   E-mail:

Bank Information(must fill Bank Information Release Form)

Please fill Bank Information Release Form

Trade Reference:   ( Minimum 3 trade reference are required)

Name:                                                              Officer:                                                               Fax:

Name:                                                              Officer:                                                               Fax:

Name:                                                              Office:                                                                Fax:

 Name:                                       Title:                                     Signatue:                               Date:

( President/Owner of the Company)