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     CREDIT APPLICATION
                                                     (please print)
     Billing     Name                                       Phone                        Fax
     Information
                 Company                                                                 E-mail
                 Street
                 City                                       State                        Zip
     Ship To     Name
     Information
     (if different   Company                                                     Commercial    Residential
     from above)
                 Street
                 City                                       State                        Zip
     Ownership    Individual     Partnership       Corporation    Other, explain ___________________________________
                 Principals
                 Name                                       Address                      City, State, Zip
                 Federal I.D. Number
                 Years in Business
     Customer    1.  PO required?           yes   no           4.  Require fax or email
     Special     2.  Monthly statements?    yes   no              acknowledgments on all orders.   yes   no
     Conditions     If yes, do you want:    Email    Fax    Mail  5.  Print your part # on packing slip?   yes   no
     (circle your      If no, you will only receive invoice. How do you want to   6.  Designate orders to:
     choice)        receive your invoice?   Email    Fax    Mail     a.  ship complete / no back orders
                 3.  Print prices on packing slip?   yes   no     b.  ship complete unless otherwise specified
                    (not recommended for those                    c.  ship partials / ship back orders complete
                    using our drop ship program)                  d.  ship partials / ship back orders as they come in
     Bank        Bank Name                                  Address
     Reference
                 Type of Account        Account #           Bank Officer’s Name          Phone
     Vendor
     Reference   Company                                    Fax
                 Street                                     Phone                        E-Mail
                 City                                       State                        Zip
                 Company                                    Fax
                 Street                                     Phone                        E-Mail
                 City                                       State                        Zip
                 Company                                    Fax
                 Street                                     Phone                        E-Mail
                 City                                       State                        Zip
     I the undersigned confirm that all information given in this application is true and correct to the best of my knowledge. I understand that terms on all purchases
     are net 30 days. If this application is approved, I recognize that I/we will be responsible for any attorney’s fees and/or costs incurred in the collection of any
     unpaid balance.
                                    Signature                                                Date





